Healthcare Provider Details

I. General information

NPI: 1871339903
Provider Name (Legal Business Name): REBECCA ELIZABETH WUAMETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4790 S ATLANTIC AVE UNIT D401
PONCE INLET FL
32127-7161
US

IV. Provider business mailing address

4790 S ATLANTIC AVE UNIT D401
PONCE INLET FL
32127-7161
US

V. Phone/Fax

Practice location:
  • Phone: 808-264-7943
  • Fax:
Mailing address:
  • Phone: 808-264-7943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: