Provider Demographics
NPI:1881347458
Name:WONDERLAND CONSULTING AND COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:WONDERLAND CONSULTING AND COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:917-858-2003
Mailing Address - Street 1:5471 W WATERS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1253
Mailing Address - Country:US
Mailing Address - Phone:813-512-6147
Mailing Address - Fax:813-512-6129
Practice Address - Street 1:5471 W WATERS AVE STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1253
Practice Address - Country:US
Practice Address - Phone:813-512-6147
Practice Address - Fax:813-512-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1871550509Medicaid