Provider Demographics
NPI:1356592026
Name:STONE, VIVIAN YOLANDA (LMHC)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:YOLANDA
Last Name:STONE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:YOLANDA
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:4949 NW FOXWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2302
Mailing Address - Country:US
Mailing Address - Phone:772-528-3828
Mailing Address - Fax:772-785-9588
Practice Address - Street 1:725 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-9125
Practice Address - Country:US
Practice Address - Phone:772-252-4014
Practice Address - Fax:772-999-5577
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009146600Medicaid