Provider Demographics
NPI:1427638303
Name:HEWINS, SUMONE (CCWCM-P)
Entity type:Individual
Prefix:
First Name:SUMONE
Middle Name:
Last Name:HEWINS
Suffix:
Gender:F
Credentials:CCWCM-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CROSSING BLVD APT 1309
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2869
Mailing Address - Country:US
Mailing Address - Phone:757-377-5642
Mailing Address - Fax:
Practice Address - Street 1:4700 MILLENIA BLVD STE 175
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6015
Practice Address - Country:US
Practice Address - Phone:321-332-7100
Practice Address - Fax:866-493-0920
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCWCM-P104615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health