| Jacqueline M Rita Lmhc Llc | |
|
211 E International Speedway Blvd Ste 107 Daytona Beach FL 32118-4662 | |
| (401) 486-6081 | |
| (386) 401-2414 |
| Full Name | Jacqueline M Rita Lmhc Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 211 E International Speedway Blvd Ste 107, Daytona Beach, Florida |
| Authorized Official Name and Position | Jacqueline M Rita (OWNER/PROVIDER) |
| Authorized Official Contact | 4014866081 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacqueline M Rita Lmhc Llc 1225 Ruthbern Rd Daytona Beach FL 32114-5961 Ph: (401) 486-6081 | Jacqueline M Rita Lmhc Llc 211 E International Speedway Blvd Ste 107 Daytona Beach FL 32118-4662 Ph: (401) 486-6081 |
| NPI Number | 1356137699 |
|---|---|
| Provider Enumeration Date | 04/15/2025 |
| Last Update Date | 05/30/2025 |
| Certification Date | 05/27/2025 |
| Medicare PECOS PAC ID | 9830614775 |
|---|---|
| Medicare Enrollment ID | O20250423001352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356137699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jacqueline M Rita |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598740896 PECOS PAC ID: 3678926599 Enrollment ID: I20240126003466 |
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