| John Ellison Community Recovery Center | |
|
6320 Saint Augustine Rd Ste 9a Jacksonville FL 32217-2813 | |
| (904) 661-1985 | |
| (904) 619-0984 |
| Full Name | John Ellison Community Recovery Center |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 6320 Saint Augustine Rd Ste 9a, Jacksonville, Florida |
| Authorized Official Name and Position | Tekesha Ellison (VP OF OPERATIONS) |
| Authorized Official Contact | 9048884634 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| John Ellison Community Recovery Center 6320 Saint Augustine Rd Ste 9a Jacksonville FL 32217-2813 Ph: (904) 661-1985 | John Ellison Community Recovery Center 6320 Saint Augustine Rd Ste 9a Jacksonville FL 32217-2813 Ph: (904) 661-1985 |
| NPI Number | 1306478797 |
|---|---|
| Provider Enumeration Date | 02/04/2020 |
| Last Update Date | 02/04/2020 |
| Certification Date | 02/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306478797 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
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