Provider Demographics
NPI:1134128325
Name:WOLCOTT, DORIS (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 PORT MALABAR BLVD NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5407
Mailing Address - Country:US
Mailing Address - Phone:321-729-0870
Mailing Address - Fax:321-952-2516
Practice Address - Street 1:1555 PORT MALABAR BLVD NE
Practice Address - Street 2:SUITE 104
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5407
Practice Address - Country:US
Practice Address - Phone:321-729-0870
Practice Address - Fax:321-952-2516
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0000570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health