Provider Demographics
NPI:1295944148
Name:AVALONE, NANCY (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:AVALONE
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MAYES FARM TRL NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5623
Mailing Address - Country:US
Mailing Address - Phone:727-480-7504
Mailing Address - Fax:
Practice Address - Street 1:15120 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-6725
Practice Address - Country:US
Practice Address - Phone:727-480-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11264101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC012246OtherSECRETARY OF STATE LICENSING