| Andbtcop Inc | |
|
320 1st St N Ste 612 Jacksonville Beach FL 32250-6947 | |
| (334) 647-1009 | |
| (888) 856-7677 |
| Full Name | Andbtcop Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 320 1st St N Ste 612, Jacksonville Beach, Florida |
| Authorized Official Name and Position | Jefkida Lasha Johnson (CEO) |
| Authorized Official Contact | 3343200084 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Andbtcop Inc 320 1st St N Ste 612 Jacksonville Beach FL 32250-6947 Ph: (334) 647-1009 | Andbtcop Inc 320 1st St N Ste 612 Jacksonville Beach FL 32250-6947 Ph: (334) 647-1009 |
| NPI Number | 1306104872 |
|---|---|
| Provider Enumeration Date | 05/02/2012 |
| Last Update Date | 04/26/2022 |
| Certification Date | 04/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306104872 | NPI | - | NPPES |
| 840832 | Medicaid | FL | |
| 241522 | Medicaid | AL |
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