Healthcare Provider Details

I. General information

NPI: 1053755603
Provider Name (Legal Business Name): JENNIFER WHITFIELD LMHC, NCC, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 07/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ROBIN RD SUITE 2006
ALTAMONTE SPRINGS FL
32701-5035
US

IV. Provider business mailing address

108 ROBIN RD SUITE 2006
ALTAMONTE SPRINGS FL
32701-5035
US

V. Phone/Fax

Practice location:
  • Phone: 407-800-3881
  • Fax: 407-831-2881
Mailing address:
  • Phone: 407-800-3881
  • Fax: 407-831-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: