| Kalena Smith-fulwiley, Llc | |
|
422 New Berlin Rd Jacksonville FL 32218-3827 | |
| (904) 269-0886 | |
| Not Available |
| Full Name | Kalena Smith-fulwiley, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 422 New Berlin Rd, Jacksonville, Florida |
| Authorized Official Name and Position | Kalena Smith-fulwiley (OWNER) |
| Authorized Official Contact | 9044769064 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kalena Smith-fulwiley, Llc 15597 Spotted Saddle Cir Jacksonville FL 32218-7984 Ph: (904) 476-9064 | Kalena Smith-fulwiley, Llc 422 New Berlin Rd Jacksonville FL 32218-3827 Ph: (904) 269-0886 |
| NPI Number | 1538608112 |
|---|---|
| Provider Enumeration Date | 02/16/2017 |
| Last Update Date | 02/16/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538608112 | NPI | - | NPPES |
| 010404400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MH12125 (Florida) | Primary |
| 251S00000X | Community/behavioral Health | MH12125 (Florida) | Secondary |
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