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General NPI Number Information
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NPI Number | 1881246148
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Entity Type | Individual
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Provider Name | ASHLEY WAKNINE
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Gender | Female
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 370 CAMINO GARDENS BLVD
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City | BOCA RATON
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State | FL
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Zip | 33432-5816
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Country | US
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Telephone | 47-256-1288
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Fax |
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Provider Business Mailing Address
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Address Line | 723 TIVOLI CIR APT 203
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-8140
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Country | US
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Telephone | 818-665-5474
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH18512
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License Number State | FL
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