Individual
MS. BRENDA LEE STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, CAP, NCC
Contact information
Practice address
3302 GREEN ST, MIMS, FL 32754-3813
(321) 268-8828
(321) 567-0888
Mailing address
PO BOX 321, MIMS, FL 32754-0321
(321) 268-8828
(321) 567-0888
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH5982
FL
Other
Enumeration date
01/15/2007
Last updated
07/12/2008
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