Healthcare Provider Details

I. General information

NPI: 1952453052
Provider Name (Legal Business Name): MARCIA WINNER LAO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/25/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 ELGIN ST
SEBRING FL
33875-1325
US

IV. Provider business mailing address

510 ELGIN ST
SEBRING FL
33875-1325
US

V. Phone/Fax

Practice location:
  • Phone: 863-414-7041
  • Fax: 863-382-6299
Mailing address:
  • Phone: 863-414-7041
  • Fax: 863-382-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH2867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: