Provider Demographics
NPI:1871904011
Name:WILEY, ROY B I (LMHC)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:B
Last Name:WILEY
Suffix:I
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 ORMOND PKWY
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-8139
Mailing Address - Country:US
Mailing Address - Phone:386-453-5092
Mailing Address - Fax:
Practice Address - Street 1:4550 ORANGE BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9108
Practice Address - Country:US
Practice Address - Phone:800-614-4124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 1181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health