Most Relevant Information
Provider Data
| NPI Number: | 1003042151 |
| Provider Name: | FREDERICKA C WILFONG M.DIV |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: | IMT2141 |
Most Important Dates
| Enumeration Date: | 06/03/2009 |
| Last Updated: | 10/19/2015 |
Provider Practice Location
1009 MAITLAND CENTER COMMONS BLVD
SUITE 212
MAITLAND
FL
327517270
Practice Location Phone/Fax
| Phone: | 8008402528 |
| Fax: |
Provider Mailing Location
7729 PINEAPPLE DR
ORLANDO
FL
328355311
Provider Mailing Phone/Fax
| Phone: | 3212766692 |
| Fax: |