| Doctor Name: | MRS. FREDERICKA C WILFONG |
| NPI Number: | 1003042151 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.DIV |
| License Number: | IMT2141 |
| Business Practice Address: | 1009 Maitland Center Commons Blvd Suite 212 Maitland, FL - 327517270 |
| Business Phone Number: | 8008402528 |
| Business Fax Number: | |
| Mailing Address: | 7729 Pineapple Dr, ORLANDO |
| State: | FL |
| Postal Code: | 328355311 |
| Phone Number: | 3212766692 |
| Fax Number: | |
| NPI Enumeration Date: | 06/03/2009 |
| NPI Last Update Date: | 10/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | IMT2141 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |