Healthcare Provider Details

I. General information

NPI: 1871401604
Provider Name (Legal Business Name): ANNE W PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 WAYMONT CT STE 100
LAKE MARY FL
32746-3475
US

IV. Provider business mailing address

1181 CHESSINGTON CIR
LAKE MARY FL
32746-1912
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-1979
  • Fax:
Mailing address:
  • Phone: 703-310-9983
  • Fax: 703-310-9983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: