Provider Demographics
NPI:1316098692
Name:BABCOCK, GLORIDA JEAN (LMHC)
Entity type:Individual
Prefix:
First Name:GLORIDA
Middle Name:JEAN
Last Name:BABCOCK
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 1:761 MONROE HARBOR PL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-6452
Mailing Address - Country:US
Mailing Address - Phone:407-323-3589
Mailing Address - Fax:407-323-2374
Practice Address - Street 1:2298 W AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3084
Practice Address - Country:US
Practice Address - Phone:407-268-4447
Practice Address - Fax:407-323-2374
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8106101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health