Provider Information for 1366035412
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MARDI LEE WEATHERFORD-MITCHELL LCSW
Sex: Female
NPI: 1366035412
Last Updated: 2021-02-18
Certification Date: 2021-02-18
Certification Date: 2021-02-18
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1366035412 | ||||||||
| Enumeration Date | 2021-02-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 12212 PICKET FENCE CT ORLANDO, FL 32828-9157 United States Phone: 321-663-7414 | Fax: | ||||||||
| Primary Practice Address | 12212 PICKET FENCE CT ORLANDO, FL 32828-9157 United States Phone: 321-663-7414 | Fax: | ||||||||
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