Provider Demographics
NPI:1952859720
Name:WAHILA, LINDSAY (LMHC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:WAHILA
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 1:10780 SW COUNTY ROAD 22
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-5318
Mailing Address - Country:US
Mailing Address - Phone:904-229-9927
Mailing Address - Fax:
Practice Address - Street 1:10780 SW COUNTY ROAD 22
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-5318
Practice Address - Country:US
Practice Address - Phone:904-229-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14508171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor