Doctor Name: | EDNA LEE WINTERBERRY |
NPI Number: | 1013109065 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH7974 |
Business Practice Address: | 4300 Bayou Blvd Ste 35 Pensacola, FL - 325032671 |
Business Phone Number: | 8503846283 |
Business Fax Number: | 8504793891 |
Mailing Address: | 4300 Bayou Blvd Ste 35, PENSACOLA |
State: | FL |
Postal Code: | 325032671 |
Phone Number: | 8503846283 |
Fax Number: | 8504793891 |
NPI Enumeration Date: | 08/14/2007 |
NPI Last Update Date: | 05/11/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH7974 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |