MEDICARE: NASSAU COUNTY MENTAL HEALTH ALCOHOL & DRUG ABUSE COUNCIL INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1669196382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASSAU COUNTY MENTAL HEALTH ALCOHOL & DRUG ABUSE COUNCIL INC

Provider Business Mailing Address
First Line	:	463142 STATE ROAD 200
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-5554
Country	:	US
Telephone Number	:	904-225-8280
Fax Number	:	904-225-8232

Provider Business Practice Location Address
First Line	:	1541 S 14TH ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-3049
Country	:	US
Telephone Number	:	904-225-8280
Fax Number	:	904-225-8232

Authorized Official
Title or Position	:	HR GENERALIST
Name	:	BRENDA HICKOX
Credential	:
Telephone Number	:	904-225-8280

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	09/27/2022

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