Provider Demographics
NPI:1366035412
Name:WEATHERFORD-MITCHELL, MARDI LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARDI
Middle Name:LEE
Last Name:WEATHERFORD-MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12212 PICKET FENCE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9157
Mailing Address - Country:US
Mailing Address - Phone:321-663-7414
Mailing Address - Fax:
Practice Address - Street 1:12212 PICKET FENCE CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9157
Practice Address - Country:US
Practice Address - Phone:321-663-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL128461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical