Individual
ANNA MIRIAM AGATINA WYKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
10151 DEERWOOD PARK BLVD # 200, JACKSONVILLE, FL 32256-0566
(904) 704-2527
Mailing address
2223 ASTOR ST UNIT 7, ORANGE PARK, FL 32073-5668
(904) 333-0881
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH18808
FL
Other
Enumeration date
05/09/2019
Last updated
02/19/2021
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