Provider Demographics
NPI:1447974076
Name:WOLLITZ, NYRLA THAIS (LMHC)
Entity type:Individual
Prefix:
First Name:NYRLA
Middle Name:THAIS
Last Name:WOLLITZ
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 1:1215 NOTTINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1101
Mailing Address - Country:US
Mailing Address - Phone:407-760-0420
Mailing Address - Fax:
Practice Address - Street 1:1133 LOUISIANA AVE STE 202
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2350
Practice Address - Country:US
Practice Address - Phone:407-760-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health