Individual
MRS. FABRAY DEALOW SMITH-WIGGINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
124 NW MADISON ST, LAKE CITY, FL 32055-3922
(386) 209-0619
Mailing address
3200 NW LAKE JEFFERY RD, LAKE CITY, FL 32055-4773
(386) 209-0619
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW22559
FL
Other
Enumeration date
09/30/2013
Last updated
11/08/2024
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