Provider Demographics
NPI:1699515270
Name:GREENBERG-AKINS, FAWN SIMONE (RMHI)
Entity type:Individual
Prefix:MRS
First Name:FAWN
Middle Name:SIMONE
Last Name:GREENBERG-AKINS
Suffix:
Gender:F
Credentials:RMHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BIRKDALE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-2053
Mailing Address - Country:US
Mailing Address - Phone:347-886-5725
Mailing Address - Fax:
Practice Address - Street 1:1635 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-8427
Practice Address - Country:US
Practice Address - Phone:386-788-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health