Provider Demographics
NPI:1881909612
Name:WOOTEN, LORNA DENISE (LMHC)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:DENISE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 HONEY RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2393
Mailing Address - Country:US
Mailing Address - Phone:407-733-8620
Mailing Address - Fax:
Practice Address - Street 1:323 E KENNEDY BLVD
Practice Address - Street 2:#G
Practice Address - City:EATONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32751-5381
Practice Address - Country:US
Practice Address - Phone:407-733-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health