Provider Demographics
NPI:1003942640
Name:WILLMING, MARILYN DONNA (LMHC, RN, CAP, CPP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:DONNA
Last Name:WILLMING
Suffix:
Gender:F
Credentials:LMHC, RN, CAP, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W. BROADWAY STREET
Mailing Address - Street 2:SUITE 107
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:407-687-7122
Mailing Address - Fax:407-365-5762
Practice Address - Street 1:128 W. BROADWAY STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:407-687-7122
Practice Address - Fax:407-687-7122
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7959101YM0800X
FLRN1489872163W00000X
FLCAP2460101YA0400X
FLRN 1489872163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health