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2950 Halcyon Ln Suite 701 Jacksonville FL 32223-6689 | |
| (904) 292-2407 | |
| (904) 292-2409 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2950 Halcyon Ln, Jacksonville, Florida |
| Authorized Official Name and Position | Carmella C Gardner (OWNER) |
| Authorized Official Contact | 9042922497 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3681 Carol Ann Ln Jacksonville FL 32223-7394 Ph: (904) 292-2407 | 2950 Halcyon Ln Suite 701 Jacksonville FL 32223-6689 Ph: (904) 292-2407 |
| NPI Number | 1275998767 |
|---|---|
| Provider Enumeration Date | 12/28/2015 |
| Last Update Date | 02/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275998767 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MH8370 (Florida) | Primary |
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