Provider Demographics
NPI:1063158889
Name:WAKEFIELD, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6113 PHEASANT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6988
Mailing Address - Country:US
Mailing Address - Phone:386-627-3033
Mailing Address - Fax:
Practice Address - Street 1:2004 KAREN LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-4029
Practice Address - Country:US
Practice Address - Phone:386-627-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor