Individual
MRS. LYNDA A GONSALVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
220 N LAKE CT, KISSIMMEE, FL 34743
(321) 236-3587
(321) 250-7822
Mailing address
220 N LAKE CT, KISSIMMEE, FL 34743-8100
(321) 236-3587
(321) 250-7822
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
103T00000X
Psychologist
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006262800
—
FL
Enumeration date
05/24/2012
Last updated
06/06/2018
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