Individual
PHOENIX FULLENWIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
630 FORTANINI CIR, OCOEE, FL 34761-5077
(321) 464-9672
Mailing address
630 FORTANINI CIR, OCOEE, FL 34761-5077
(321) 464-9672
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
FL
Other
Enumeration date
11/17/2025
Last updated
11/17/2025
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