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NPI Code Detail

MEDICARE: HEALING SPIRIT COUNSELING CENTER, LLC

MEDICARE: HEALING SPIRIT COUNSELING CENTER, LLC
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
1251S00000XCommunity/Behavioral Health AgencyMH7879FL

General Provider Information

NPI Number : 1477908853
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALING SPIRIT COUNSELING CENTER, LLC
Provider Business Mailing Address
First Line : 2200 MARSH HAWK LANE 305
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-6334
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4609 US HIGHWAY 17 STE 1
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-4818
Country : US
Telephone Number : 904-214-5109
Fax Number :
Authorized Official
Title or Position : CEO
Name : KATHLEEN EDWARDS
Credential : RD, LMHC, CIC
Telephone Number : 904-214-5109
Provider Enumeration Date : 05/04/2016
Last Update Date : 05/04/2016

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