| Avantzi Integrative Behavioral Health Llc | |
|
5011 Gate Parkway Building 100 Suite 100 Jacksonville FL 32256 | |
| (904) 718-9672 | |
| Not Available |
| Full Name | Avantzi Integrative Behavioral Health Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5011 Gate Parkway, Jacksonville, Florida |
| Authorized Official Name and Position | Katreva Dupont (DIRECTOR) |
| Authorized Official Contact | 9047189672 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avantzi Integrative Behavioral Health Llc 5011 Gate Parkway Building 100 Suite 100 Jacksonville FL 32256 Ph: (904) 718-9672 | Avantzi Integrative Behavioral Health Llc 5011 Gate Parkway Building 100 Suite 100 Jacksonville FL 32256 Ph: (904) 718-9672 |
| NPI Number | 1417625419 |
|---|---|
| Provider Enumeration Date | 09/02/2021 |
| Last Update Date | 09/08/2021 |
| Certification Date | 09/08/2021 |
| Medicare PECOS PAC ID | 4880075662 |
|---|---|
| Medicare Enrollment ID | O20220726000845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417625419 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Katreva Dupont |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801289822 PECOS PAC ID: 7214204627 Enrollment ID: I20220726000903 |
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