Provider Demographics
NPI:1629835848
Name:WONSKI, MICHAEL III (LMHC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WONSKI
Suffix:III
Gender:M
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:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34739-0216
Mailing Address - Country:US
Mailing Address - Phone:321-831-7202
Mailing Address - Fax:
Practice Address - Street 1:3940 SIX MILE RD
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34739
Practice Address - Country:US
Practice Address - Phone:321-831-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23400101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor