| River's Edge Counseling, Pllc | |
|
43 Knight Boxx Rd Ste 1 Orange Park FL 32065-7395 | |
| (904) 379-8675 | |
| (904) 423-0490 |
| Full Name | River's Edge Counseling, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 43 Knight Boxx Rd, Orange Park, Florida |
| Authorized Official Name and Position | Amanda Hannah (OWNER) |
| Authorized Official Contact | 9043798675 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| River's Edge Counseling, Pllc 43 Knight Boxx Rd Ste 1 Orange Park FL 32065-7395 Ph: (904) 379-8675 | River's Edge Counseling, Pllc 43 Knight Boxx Rd Ste 1 Orange Park FL 32065-7395 Ph: (904) 379-8675 |
| NPI Number | 1396155768 |
|---|---|
| Provider Enumeration Date | 05/06/2014 |
| Last Update Date | 01/12/2017 |
| Medicare PECOS PAC ID | 3577844091 |
|---|---|
| Medicare Enrollment ID | O20161221000799 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396155768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 12220 (Florida) | Primary |
| Provider Name | O'neil Richards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578952271 PECOS PAC ID: 9931418233 Enrollment ID: I20161229000601 |
| Provider Name | John R Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093955775 PECOS PAC ID: 5890072276 Enrollment ID: I20170512001239 |
| Provider Name | Whitney R Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386198430 PECOS PAC ID: 1658633318 Enrollment ID: I20180319000783 |
| Provider Name | Edwin Hannah |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689207243 PECOS PAC ID: 0143600338 Enrollment ID: I20220706001233 |
| Provider Name | Amanda Hannah |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891116968 PECOS PAC ID: 2567743081 Enrollment ID: I20240110000485 |
| Provider Name | Pamela Mccormick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669127122 PECOS PAC ID: 5294188975 Enrollment ID: I20240130000171 |
| Provider Name | Janel Falvey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972926970 PECOS PAC ID: 0648615179 Enrollment ID: I20240223003083 |
| Provider Name | Melissa Taylor |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1275288722 PECOS PAC ID: 1254779929 Enrollment ID: I20240401003213 |
| Provider Name | Nichole Demoya |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578014205 PECOS PAC ID: 4688012859 Enrollment ID: I20240406000433 |
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