Active NPI
Fredericka C Wilfong, M.DIV
- Counselor
- Maitland, FL
National Provider Identifier
1003042151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- IMT2141
- Practice address
- 1009 Maitland Center Commons Blvd
Suite 212
Maitland, FL 32751-7270 - Phone
- (800) 840-2528
- NPI assigned
- Jun 3, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | IMT2141 | FL | Primary |
Addresses
Primary practice location
1009 Maitland Center Commons Blvd
Suite 212
Maitland, FL 32751-7270
Mailing address
7729 Pineapple Dr
Orlando, FL 32835-5311
Phone (321) 276-6692
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMT2141 | FL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445212800000",
"number": "1003042151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7729 PINEAPPLE DR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328355311",
"telephone_number": "321-276-6692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1009 MAITLAND CENTER COMMONS BLVD",
"address_2": "SUITE 212",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327517270",
"telephone_number": "800-840-2528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILFONG",
"first_name": "FREDERICKA",
"middle_name": "C",
"name_prefix": "Mrs.",
"credential": "M.DIV",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-03",
"last_updated": "2015-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "FL",
"license": "IMT2141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maitland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.