Provider Demographics
NPI:1811938848
Name:CRANDALL, JOANNE (LMHC)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:COLEMAN-CRANDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 495755
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949
Mailing Address - Country:US
Mailing Address - Phone:941-766-9555
Mailing Address - Fax:941-766-1511
Practice Address - Street 1:3191 HARBOR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-766-9555
Practice Address - Fax:941-766-1511
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health