Provider Demographics
NPI:1689461196
Name:THEOC, WILMA
Entity type:Individual
Prefix:MS
First Name:WILMA
Middle Name:
Last Name:THEOC
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 NW 73RD TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-6315
Mailing Address - Country:US
Mailing Address - Phone:786-200-8821
Mailing Address - Fax:
Practice Address - Street 1:5270 NW 73RD TER
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-6315
Practice Address - Country:US
Practice Address - Phone:786-200-8821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH26438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health