Provider Demographics
NPI:1962574319
Name:HOTALING, MARJORIE WILLIAMS (EDD, LMHC)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:WILLIAMS
Last Name:HOTALING
Suffix:
Gender:F
Credentials:EDD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PINEAPPLE LN
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5812
Mailing Address - Country:US
Mailing Address - Phone:407-788-4597
Mailing Address - Fax:
Practice Address - Street 1:580 OLD SANFORD OVIEDO RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-2637
Practice Address - Country:US
Practice Address - Phone:407-327-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0003986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH0003986OtherMENTAL HEALTH COUNSELOR
PAPS004930LOtherPSYCHOLOGIST