MEDICARE: MOMENTUM COUNSELING

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	104100000X	Social Worker	SW9543	FL

General Provider Information

NPI Number	:	1245562644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENTUM COUNSELING

Provider Business Mailing Address
First Line	:	320 1ST ST N STE 613
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-6947
Country	:	US
Telephone Number	:	904-874-9760
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 1ST ST N STE 613
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-6947
Country	:	US
Telephone Number	:	904-874-9760
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAWN L DIRITO
Credential	:	LCSW
Telephone Number	:	904-874-9760

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	01/19/2011

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Directions to “MOMENTUM COUNSELING ” Practice Location

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