Healthcare Provider Details

I. General information

NPI: 1356798599
Provider Name (Legal Business Name): TINA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 ARLINGTON ST
ORLANDO FL
32805-1107
US

IV. Provider business mailing address

750 S ORANGE BLOSSOM TRL SUITE-229
ORLANDO FL
32805-3118
US

V. Phone/Fax

Practice location:
  • Phone: 407-745-5022
  • Fax:
Mailing address:
  • Phone: 407-745-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH-012666-2016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: