MEDICARE: ENITAN COUNSELING AND COACHING SERVICES

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1588251599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENITAN COUNSELING AND COACHING SERVICES

Provider Business Mailing Address
First Line	:	3100 UNIVERSITY BLVD S STE 218
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2727
Country	:	US
Telephone Number	:	904-834-9843
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 UNIVERSITY BLVD S STE 218
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2727
Country	:	US
Telephone Number	:	904-834-9843
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIE VERNAL
Credential	:	LCSW
Telephone Number	:	718-316-2899

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	02/02/2021

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