Doctor Name: | MRS. JUDITH ANNE' WISEMAN |
NPI Number: | 1043451453 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC-S |
License Number: | MH6684 |
Business Practice Address: | 22 Bluewater Point Rd Niceville, FL - 325784503 |
Business Phone Number: | 8508975852 |
Business Fax Number: | |
Mailing Address: | 22 Bluewater Point Rd, NICEVILLE |
State: | FL |
Postal Code: | 325784503 |
Phone Number: | 8508975852 |
Fax Number: | |
NPI Enumeration Date: | 03/13/2009 |
NPI Last Update Date: | 03/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH6684 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |