MEDICARE: WONDERFUL ADMIRABLE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1689530453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONDERFUL ADMIRABLE CARE LLC

Provider Business Mailing Address
First Line	:	11656 FOX CREEK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-1508
Country	:	US
Telephone Number	:	917-858-2003
Fax Number	:	917-858-2003

Provider Business Practice Location Address
First Line	:	11656 FOX CREEK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-1508
Country	:	US
Telephone Number	:	917-858-2003
Fax Number	:	917-858-2003

Authorized Official
Title or Position	:	OWNER
Name	:	PRISCILLA ESTERVINA MOLINA
Credential	:	LMFT
Telephone Number	:	917-858-2003

Provider Enumeration Date	:	12/24/2025
Last Update Date	:	12/24/2025

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