Individual
GINA LYNN VIVALDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
710 EXECUTIVE PARK DR STE 11, GREENWOOD, IN 46143-2385
(317) 788-7733
Mailing address
645 S ROGERS ST, BLOOMINGTON, IN 47403-2353
(812) 339-1691
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39004691A
IN
Other
Enumeration date
08/14/2019
Last updated
02/16/2024
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