Provider Demographics
NPI:1881991396
Name:COLON, ANICA ILLIANA (RCSWI)
Entity type:Individual
Prefix:MRS
First Name:ANICA
Middle Name:ILLIANA
Last Name:COLON
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S SWOOPE AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5786
Mailing Address - Country:US
Mailing Address - Phone:407-699-0444
Mailing Address - Fax:407-928-0444
Practice Address - Street 1:225 S SWOOPE AVE STE 211
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5786
Practice Address - Country:US
Practice Address - Phone:407-699-0444
Practice Address - Fax:407-928-0444
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW39401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical