Provider Demographics
NPI:1578946448
Name:FOLSOM, DENISE (MS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6013 N STAR DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-5338
Mailing Address - Country:US
Mailing Address - Phone:850-784-1758
Mailing Address - Fax:
Practice Address - Street 1:2615 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2339
Practice Address - Country:US
Practice Address - Phone:850-331-0134
Practice Address - Fax:850-306-6721
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH12470101YM0800X
FLMH1247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health