MEDICARE: INTERNATIONAL ACADEMY OF CULTURAL FREE COUNSELING AND PSYCHOTHERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MH0054	FL

General Provider Information

NPI Number	:	1093854192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL ACADEMY OF CULTURAL FREE COUNSELING AND PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	2457 SOUTHERN LINKS DRIVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32003
Country	:	US
Telephone Number	:	904-269-4481
Fax Number	:	904-269-4481

Provider Business Practice Location Address
First Line	:	2457 SOUTHERN LINKS DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32003-6356
Country	:	US
Telephone Number	:	904-269-4481
Fax Number	:	904-269-4481

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. WILLIAM CARNELL JONES
Credential	:	LMHC
Telephone Number	:	904-269-4481

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/22/2020

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