Basic Information
| Provider Information | |||||||||
| NPI: | 1437422276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWKIRK | ||||||||
| FirstName: | CAROLE | ||||||||
| MiddleName: | WELLING | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A., LMHC, NCC, CRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 W SADIE ST | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335104440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134385949 | ||||||||
| FaxNumber: | 8134385951 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 W SADIE ST | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335104440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134385949 | ||||||||
| FaxNumber: | 8134385951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2012 | ||||||||
| LastUpdateDate: | 02/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH5967 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | MH5967 | 01 | FL | STATE OF FLORIDA | OTHER |