Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH5412 | FL |
NPI | 1003073412 |
---|---|
Provider Name | Ms. Susan Wachter |
First Address | Maitland, FL 32751 |
Second Address | Maitland, FL 32751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 22/05/2008 |