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General NPI Number Information
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NPI Number | 1518389774
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Entity Type | Individual
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Provider Name | KATHERINE MAE EFSTRATION WINHAM LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 2380 3RD ST S SUITE 2
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-4072
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Country | US
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Telephone | 902-662-6130
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Fax |
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Provider Business Mailing Address
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Address Line | 111 ABALONE LN W
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-2401
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Country | US
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Telephone | 770-307-7707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 2819
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License Number State | FL
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