Provider Demographics
NPI:1538118641
Name:MACDUFFIE, MARGARET FANNING (LMHC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:FANNING
Last Name:MACDUFFIE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 S RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4927
Mailing Address - Country:US
Mailing Address - Phone:386-258-1700
Mailing Address - Fax:386-672-0014
Practice Address - Street 1:435 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4927
Practice Address - Country:US
Practice Address - Phone:386-258-1700
Practice Address - Fax:386-672-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7611587 00Medicaid