Provider Demographics
NPI:1932106903
Name:WEIRI-KOLLE, KARIN CHARLOTTA (LMFT)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:CHARLOTTA
Last Name:WEIRI-KOLLE
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 1:2425 S VOLUSIA AVE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7625
Mailing Address - Country:US
Mailing Address - Phone:386-848-5170
Mailing Address - Fax:386-740-8251
Practice Address - Street 1:2425 S VOLUSIA AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7625
Practice Address - Country:US
Practice Address - Phone:386-848-5170
Practice Address - Fax:386-740-8251
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1992106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7618441 00Medicaid
FL1932106903OtherNPI