Provider Demographics
NPI:1396091468
Name:MORRIS, VA-LITA E
Entity type:Individual
Prefix:
First Name:VA-LITA
Middle Name:E
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9305
Mailing Address - Country:US
Mailing Address - Phone:239-393-2808
Mailing Address - Fax:239-939-4794
Practice Address - Street 1:3830 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9305
Practice Address - Country:US
Practice Address - Phone:239-393-2808
Practice Address - Fax:239-939-4794
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070980800Medicaid