Provider Demographics
NPI:1588912224
Name:GONCALVES VEIGA, LIDIA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LIDIA
Middle Name:
Last Name:GONCALVES VEIGA
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 1:1201 1ST ST S
Mailing Address - Street 2:SWEET CENTER
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3904
Mailing Address - Country:US
Mailing Address - Phone:863-293-1121
Mailing Address - Fax:863-291-6753
Practice Address - Street 1:1201 1ST ST S
Practice Address - Street 2:SWEET CENTER
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3904
Practice Address - Country:US
Practice Address - Phone:863-293-1121
Practice Address - Fax:863-291-6753
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health