Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | IMT2141 | FL |
NPI | 1003042151 |
---|---|
Provider Name | Mrs. Fredericka C Wilfong |
First Address | Orlando, FL 32835-5311 |
Second Address | Maitland, FL 32751-7270 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2009 |
Last Update Date | 19/10/2015 |