Provider Demographics
NPI:1083982409
Name:MIDKIFF, CHARLOTTE J (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:J
Last Name:MIDKIFF
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 HUNTERS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7230
Mailing Address - Country:US
Mailing Address - Phone:352-394-0573
Mailing Address - Fax:407-650-3073
Practice Address - Street 1:3400 HUNTERS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837
Practice Address - Country:US
Practice Address - Phone:352-394-0573
Practice Address - Fax:407-650-3073
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty