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General NPI Number Information
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NPI Number | 1942788740
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Entity Type | Individual
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Provider Name | COLLEEN WENNER-FOY MA LMHC. MCAP
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Gender | Female
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 1 11TH AVE
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City | SHALIMAR
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State | FL
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Zip | 32579-1324
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Country | US
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Telephone | 850-609-1040
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 HICKORY AVE
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City | NICEVILLE
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State | FL
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Zip | 32578-3222
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Country | US
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Telephone | 850-461-7282
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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 | MH16185
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License Number State | FL
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