Healthcare Provider Details

I. General information

NPI: 1982677126
Provider Name (Legal Business Name): VIRGINIA WAY CUCUEL L.M.F.T., L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINI WAY CUCUEL L.M.F.T., L.M.H.C.

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 HOWELL BRANCH RD SUITE B-4
WINTER PARK FL
32789-1109
US

IV. Provider business mailing address

1555 HOWELL BRANCH RD SUITE B-4
WINTER PARK FL
32789-1109
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-2121
  • Fax: 407-644-2974
Mailing address:
  • Phone: 407-644-2121
  • Fax: 407-644-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1041
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: