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11266 Lake Mandarin Cir E Jacksonville FL 32223-7811 | |
| (904) 705-6130 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 11266 Lake Mandarin Cir E, Jacksonville, Florida |
| Authorized Official Name and Position | Kelly Ann Minor (PRESIDENT) |
| Authorized Official Contact | 9047202090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7643 Gate Pkwy Ste 104-941 Jacksonville FL 32256-2893 Ph: (904) 720-2090 | 11266 Lake Mandarin Cir E Jacksonville FL 32223-7811 Ph: (904) 705-6130 |
| NPI Number | 1205445327 |
|---|---|
| Provider Enumeration Date | 07/24/2020 |
| Last Update Date | 03/16/2022 |
| Certification Date | 03/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205445327 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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