Provider Demographics
NPI:1366796260
Name:STITELER, JOHN (MA, LCCT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STITELER
Suffix:
Gender:M
Credentials:MA, LCCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 S KIRKMAN RD
Mailing Address - Street 2:#3118
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2631
Mailing Address - Country:US
Mailing Address - Phone:321-332-6984
Mailing Address - Fax:
Practice Address - Street 1:5401 S KIRKMAN RD
Practice Address - Street 2:#222
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7940
Practice Address - Country:US
Practice Address - Phone:321-332-6984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCCT 0330020611101YP1600X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education