Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CAP2460 | FL |
Y | 101YM0800X | Mental Health Counselor | MH7959 | FL |
NPI | 1003942640 |
---|---|
Provider Name | Marilyn Donna Willming |
First Address | Oviedo, FL 32765 |
Second Address | Oviedo, FL 32765 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 24/06/2011 |