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1532 Kingsley Ave Ste 112 Orange Park FL 32073-4536 | |
| (904) 214-3222 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1532 Kingsley Ave Ste 112, Orange Park, Florida |
| Authorized Official Name and Position | Christina Marie St.clair (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9042540332 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1532 Kingsley Ave Ste 112 Orange Park FL 32073-4536 Ph: (904) 214-3222 | 1532 Kingsley Ave Ste 112 Orange Park FL 32073-4536 Ph: (904) 214-3222 |
| NPI Number | 1649675687 |
|---|---|
| Provider Enumeration Date | 11/04/2014 |
| Last Update Date | 08/19/2021 |
| Certification Date | 08/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649675687 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW9011 (Florida) | Primary |
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