Provider Demographics
NPI:1548870579
Name:VANDERBERG, OWAISSA CARTER (LMFT, LMHC, CT)
Entity type:Individual
Prefix:
First Name:OWAISSA
Middle Name:CARTER
Last Name:VANDERBERG
Suffix:
Gender:F
Credentials:LMFT, LMHC, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2339
Mailing Address - Country:US
Mailing Address - Phone:352-406-9381
Mailing Address - Fax:
Practice Address - Street 1:92 W MILLER ST # MP306
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2032
Practice Address - Country:US
Practice Address - Phone:321-841-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18232101YM0800X
FL3853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health