Provider Demographics
NPI:1396086831
Name:HUGHLEY, MARVIN VANDELLAS (LMHC, CAP)
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:VANDELLAS
Last Name:HUGHLEY
Suffix:
Gender:M
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 FOREST PARK CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4915
Mailing Address - Country:US
Mailing Address - Phone:850-628-9326
Mailing Address - Fax:888-475-8203
Practice Address - Street 1:218 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4915
Practice Address - Country:US
Practice Address - Phone:850-628-9326
Practice Address - Fax:888-475-8203
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11670101YM0800X
FL5423101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)