Provider Demographics
NPI:1306591375
Name:STOVALL, DYLAN (LCSW)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:STOVALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DELILAH
Other - Middle Name:
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:247 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-2201
Mailing Address - Country:US
Mailing Address - Phone:850-401-9824
Mailing Address - Fax:
Practice Address - Street 1:1380 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2641
Practice Address - Country:US
Practice Address - Phone:850-512-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW140231041C0700X
FLSW204071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical