Healthcare Provider Details

I. General information

NPI: 1013845429
Provider Name (Legal Business Name): RONDA JARVIS LCSW, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MAGNOLIA ST
FLAGLER BEACH FL
32136-4927
US

IV. Provider business mailing address

18 MAGNOLIA ST
FLAGLER BEACH FL
32136-4927
US

V. Phone/Fax

Practice location:
  • Phone: 505-470-7315
  • Fax:
Mailing address:
  • Phone: 505-470-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. RONDA JO JARVIS
Title or Position: OWNER, THERAPIST
Credential: LCSW
Phone: 505-470-7315