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10199 Southside Blvd Ste 204 Jacksonville FL 32256-6716 | |
| (904) 917-2285 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 10199 Southside Blvd Ste 204, Jacksonville, Florida |
| Authorized Official Name and Position | Scott Sarnacke (CFO) |
| Authorized Official Contact | 6158648154 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10199 Southside Blvd Ste 204 Jacksonville FL 32256-6716 Ph: () - | 10199 Southside Blvd Ste 204 Jacksonville FL 32256-6716 Ph: (904) 917-2285 |
| NPI Number | 1073385175 |
|---|---|
| Provider Enumeration Date | 10/23/2023 |
| Last Update Date | 05/14/2024 |
| Certification Date | 05/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073385175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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