Provider Demographics
NPI:1952453052
Name:LAO, MARCIA WINNER (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:WINNER
Last Name:LAO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:107 MEDICAL CENTER AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5423
Mailing Address - Country:US
Mailing Address - Phone:863-382-9280
Mailing Address - Fax:863-382-6299
Practice Address - Street 1:107 MEDICAL CENTER AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5423
Practice Address - Country:US
Practice Address - Phone:863-382-9280
Practice Address - Fax:863-382-6299
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2867101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health