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General NPI Number Information
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NPI Number | 1588053623
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Entity Type | Individual
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Provider Name | TERRY WHARTON
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Gender | Female
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 390 S COURTENAY PKWY
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4847
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Country | US
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Telephone | 215-559-1184
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 PINE ISLAND RD
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-6517
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Country | US
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Telephone | 215-559-1184
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 204811419
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License Number State | FL
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