| Doctor Name: | STEPHANIE ANN FRETWELL |
| NPI Number: | 1619392982 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.M.H.C |
| License Number: | 12244 |
| Business Practice Address: | 100 W College Dr Bldg E Avon Park, FL - 338259348 |
| Business Phone Number: | 8634520106 |
| Business Fax Number: | 8634525376 |
| Mailing Address: | 100 W College Dr, Bldg E AVON PARK |
| State: | FL |
| Postal Code: | 338259348 |
| Phone Number: | 8634520106 |
| Fax Number: | 8634525376 |
| NPI Enumeration Date: | 02/24/2014 |
| NPI Last Update Date: | 02/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 12244 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |