Provider Demographics
NPI:1700994761
Name:VAILLETTE, NORMA JOANNE (LMHC, MT-BC)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:JOANNE
Last Name:VAILLETTE
Suffix:
Gender:F
Credentials:LMHC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-4841
Mailing Address - Country:US
Mailing Address - Phone:863-284-0817
Mailing Address - Fax:863-284-0608
Practice Address - Street 1:215 E OAK ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4841
Practice Address - Country:US
Practice Address - Phone:863-284-0817
Practice Address - Fax:863-284-0608
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000921800Medicaid
FL7561664OtherAETNA
FL790160-000OtherMAGELLAN
FLZ084DOtherBLUECROSS BLUESHIELD