Healthcare Provider Details

I. General information

NPI: 1851861256
Provider Name (Legal Business Name): LANICIA WANZETTA CAIN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 LAKE HOWELL RD
MAITLAND FL
32751-5900
US

IV. Provider business mailing address

1850 LEE RD STE 322
WINTER PARK FL
32789-2107
US

V. Phone/Fax

Practice location:
  • Phone: 407-575-9102
  • Fax: 407-558-3438
Mailing address:
  • Phone: 407-637-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: