Provider Demographics
NPI:1942788740
Name:WENNER-FOY, COLLEEN (MA LMHC MCAP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:WENNER-FOY
Suffix:
Gender:F
Credentials:MA LMHC MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3222
Mailing Address - Country:US
Mailing Address - Phone:850-461-7282
Mailing Address - Fax:
Practice Address - Street 1:1 11TH AVE
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1324
Practice Address - Country:US
Practice Address - Phone:850-609-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16185101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health