Healthcare Provider Details

I. General information

NPI: 1790620292
Provider Name (Legal Business Name): MAISHA WILDER RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 PALMETTO AVE
WINTER PARK FL
32789-4964
US

IV. Provider business mailing address

5167 WELLINGTON PARK CIR APT D27
ORLANDO FL
32839-4604
US

V. Phone/Fax

Practice location:
  • Phone: 407-714-6362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: