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1335 Kingsley Ave # 2472 Orange Park FL 32073-4507 | |
| (904) 329-0028 | |
| (866) 818-7176 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1335 Kingsley Ave # 2472, Orange Park, Florida |
| Authorized Official Name and Position | Alysia Gilliam (BOARD CERTIFIED BEHAVIOR ANALYST) |
| Authorized Official Contact | 9043290028 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1335 Kingsley Ave # 2472 Orange Park FL 32073-4507 Ph: (904) 329-0028 | 1335 Kingsley Ave # 2472 Orange Park FL 32073-4507 Ph: (904) 329-0028 |
| NPI Number | 1790008878 |
|---|---|
| Provider Enumeration Date | 03/03/2010 |
| Last Update Date | 02/28/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790008878 | NPI | - | NPPES |
| 019773100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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