Provider Demographics
NPI:1275505349
Name:WENIG, TARA MICHELLE (MA, LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:MICHELLE
Last Name:WENIG
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 DOUGLAS AVE STE 200517
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2517
Mailing Address - Country:US
Mailing Address - Phone:407-595-6393
Mailing Address - Fax:
Practice Address - Street 1:445 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2591
Practice Address - Country:US
Practice Address - Phone:407-595-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL294794Medicaid