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1857 Wells Rd Ste 2016 Orange Park FL 32073-2338 | |
| (904) 523-1287 | |
| (904) 615-6919 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1857 Wells Rd Ste 2016, Orange Park, Florida |
| Authorized Official Name and Position | Kenia N. Davila Ortiz (PRESIDENT) |
| Authorized Official Contact | 9045231287 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
250 Cherry Ridge Dr Apt 1219 Jacksonville FL 32222-2870 Ph: (904) 523-1287 | 1857 Wells Rd Ste 2016 Orange Park FL 32073-2338 Ph: (904) 523-1287 |
| NPI Number | 1992571012 |
|---|---|
| Provider Enumeration Date | 11/29/2023 |
| Last Update Date | 01/17/2025 |
| Certification Date | 01/17/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992571012 | NPI | - | NPPES |
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