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752 Blanding Blvd Ste 131 Orange Park FL 32065-5796 | |
| (904) 830-0737 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Pastoral |
| Location | 752 Blanding Blvd Ste 131, Orange Park, Florida |
| Authorized Official Name and Position | Pamela Russell Russell (CEO) |
| Authorized Official Contact | 9048300737 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
752 Blanding Blvd Ste 131 Orange Park FL 32065-5796 Ph: (904) 830-0737 | 752 Blanding Blvd Ste 131 Orange Park FL 32065-5796 Ph: (904) 830-0737 |
| NPI Number | 1295353951 |
|---|---|
| Provider Enumeration Date | 07/09/2020 |
| Last Update Date | 08/13/2024 |
| Certification Date | 08/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295353951 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP1600X | Counselor - Pastoral | (* (Not Available)) | Primary |
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