Provider Demographics
NPI:1295060523
Name:VANWULFEN, LINDA A (MA, MSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:A
Last Name:VANWULFEN
Suffix:
Gender:F
Credentials:MA, MSW
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 421
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170-0421
Mailing Address - Country:US
Mailing Address - Phone:386-290-2220
Mailing Address - Fax:
Practice Address - Street 1:1250 ANDREWS CIR
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-2132
Practice Address - Country:US
Practice Address - Phone:904-964-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor