Provider Demographics
NPI:1811318173
Name:NODZON, JOAN (LMHC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:NODZON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 N MCMULLEN BOOTH RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1362
Mailing Address - Country:US
Mailing Address - Phone:727-457-1000
Mailing Address - Fax:727-725-0389
Practice Address - Street 1:2451 N MCMULLEN BOOTH RD STE 220
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1362
Practice Address - Country:US
Practice Address - Phone:727-457-1000
Practice Address - Fax:727-725-0389
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1811318173Medicaid