Provider Demographics
NPI:1013155274
Name:TOUSSAINT, KWANYA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KWANYA
Middle Name:
Last Name:TOUSSAINT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:KWANYA
Other - Middle Name:
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:3270 SUNTREE BLVD STE 127
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7540
Mailing Address - Country:US
Mailing Address - Phone:321-610-7949
Mailing Address - Fax:321-610-7947
Practice Address - Street 1:3270 SUNTREE BLVD STE 127
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7540
Practice Address - Country:US
Practice Address - Phone:321-610-7949
Practice Address - Fax:321-610-7947
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764241500Medicaid
FL076875800Medicaid