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4693 Salisbury Rd Rm 136 Jacksonville FL 32256-6129 | |
| (727) 358-4840 | |
| (833) 561-2501 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 4693 Salisbury Rd Rm 136, Jacksonville, Florida |
| Authorized Official Name and Position | Kathie L Land (OWNER) |
| Authorized Official Contact | 7273584840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
382 Ne 191st St Pmb 776953 Miami FL 33179 Ph: (727) 358-4840 | 4693 Salisbury Rd Rm 136 Jacksonville FL 32256-6129 Ph: (727) 358-4840 |
| NPI Number | 1538975966 |
|---|---|
| Provider Enumeration Date | 12/10/2024 |
| Last Update Date | 01/17/2025 |
| Certification Date | 01/17/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538975966 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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