Provider Demographics
NPI:1922517739
Name:GERVAIS, VANOUCHE (NCC, LMHC, MS)
Entity Type:Individual
Prefix:
First Name:VANOUCHE
Middle Name:
Last Name:GERVAIS
Suffix:
Gender:F
Credentials:NCC, LMHC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 NW 118TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-6238
Mailing Address - Country:US
Mailing Address - Phone:904-226-0015
Mailing Address - Fax:
Practice Address - Street 1:7971 RIVIERA BLVD STE 316
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6448
Practice Address - Country:US
Practice Address - Phone:305-570-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3214106H00000X
FLMH21024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist