| |
8766 Nelson Ln Glen St Mary FL 32040-4624 | |
(904) 382-5903 | |
(904) 259-1282 |
Full Name | |
---|---|
Speciality | Counselor - Mental Health |
Location | 8766 Nelson Ln, Glen St Mary, Florida |
Authorized Official Name and Position | Tonya Joy Smith (OWNER) |
Authorized Official Contact | 9043825903 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 896 Glen St Mary FL 32040-0896 Ph: (904) 382-5903 | 8766 Nelson Ln Glen St Mary FL 32040-4624 Ph: (904) 382-5903 |
NPI Number | 1770984213 |
---|---|
Provider Enumeration Date | 09/15/2014 |
Last Update Date | 09/15/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770984213 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | MH11382 (Florida) | Primary |