Healthcare Provider Details

I. General information

NPI: 1518000736
Provider Name (Legal Business Name): WINIFRED MARY HOLLAND LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N TEMPLE AVE
STARKE FL
32091-1960
US

IV. Provider business mailing address

1030 MEADOWS DR
STARKE FL
32091-1800
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-7732
  • Fax: 904-964-3024
Mailing address:
  • Phone: 904-964-6951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: