Provider Demographics
NPI:1255776795
Name:BANDA, BERCELA KAY (LCSW)
Entity type:Individual
Prefix:
First Name:BERCELA
Middle Name:KAY
Last Name:BANDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 SW BAYA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-4209
Mailing Address - Country:US
Mailing Address - Phone:386-754-9005
Mailing Address - Fax:386-754-9017
Practice Address - Street 1:922 SW BAYA DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4209
Practice Address - Country:US
Practice Address - Phone:386-754-9005
Practice Address - Fax:386-754-9017
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW103631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical