Healthcare Provider Details

I. General information

NPI: 1528517091
Provider Name (Legal Business Name): LAURIE WOOLWINE MT 3184
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 S STATE ROAD 7 STE 315-2
WELLINGTON FL
33414-6134
US

IV. Provider business mailing address

12798 FOREST HILL BLVD STE 303
WELLINGTON FL
33414-4704
US

V. Phone/Fax

Practice location:
  • Phone: 561-237-0800
  • Fax: 561-570-1702
Mailing address:
  • Phone: 561-237-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH15414
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 3184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: