Provider Demographics
NPI:1518389774
Name:WINHAM, KATHERINE MAE EFSTRATION (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MAE EFSTRATION
Last Name:WINHAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ABALONE LN W
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2401
Mailing Address - Country:US
Mailing Address - Phone:770-307-7707
Mailing Address - Fax:
Practice Address - Street 1:2380 3RD ST S
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4072
Practice Address - Country:US
Practice Address - Phone:902-662-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist