Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003181934 |
---|---|
Provider Name | Teresita Nuguid Carmack |
First Address | Winter Haven, FL 33881-0700 |
Second Address | Winter Haven, FL 33881-0700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2012 |
Last Update Date | 10/03/2012 |