Provider Demographics
NPI:1740511583
Name:WATLER, CAROL MARIE
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:WATLER
Suffix:
Gender:F
Credentials:
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 954
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-0954
Mailing Address - Country:US
Mailing Address - Phone:407-834-0942
Mailing Address - Fax:407-834-0945
Practice Address - Street 1:238 N WESTMONTE DR STE 240
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3364
Practice Address - Country:US
Practice Address - Phone:407-834-0942
Practice Address - Fax:407-834-0945
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003785100Medicaid