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1360 Ne 175th Street Citra FL 32113-1075 | |
(352) 502-0376 | |
(352) 502-0376 |
Full Name | |
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Speciality | Counselor - Mental Health |
Location | 1360 Ne 175th Street, Citra, Florida |
Authorized Official Name and Position | Judy Ann Mcdonald (DIRECTOR/OWNER) |
Authorized Official Contact | 3525020376 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1075 Citra FL 32113-1075 Ph: (352) 502-0376 | 1360 Ne 175th Street Citra FL 32113-1075 Ph: (352) 502-0376 |
NPI Number | 1720505886 |
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Provider Enumeration Date | 08/29/2017 |
Last Update Date | 03/17/2018 |
Identifier | Type | State | Issuer |
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1720505886 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YM0800X | Counselor - Mental Health | MH7033 (Florida) | Primary |