Provider Demographics
NPI:1528411154
Name:MORALES, AWILDA JEANNETTE
Entity Type:Individual
Prefix:
First Name:AWILDA
Middle Name:JEANNETTE
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9236 RANDAL LAKES BLVD.
Mailing Address - Street 2:APT. 11110
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832
Mailing Address - Country:US
Mailing Address - Phone:939-339-3592
Mailing Address - Fax:
Practice Address - Street 1:9236 RANDAL LAKES BLVD.
Practice Address - Street 2:APT. 11110
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832
Practice Address - Country:US
Practice Address - Phone:939-339-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor