Healthcare Provider Details

I. General information

NPI: 1639962277
Provider Name (Legal Business Name): COUNSELING BY KATIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 US HIGHWAY 17 STE 103
FLEMING ISLAND FL
32003-4832
US

IV. Provider business mailing address

4375 US HIGHWAY 17 STE 103
FLEMING ISLAND FL
32003-4832
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-0886
  • Fax:
Mailing address:
  • Phone: 904-269-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATIE WESTFALL
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 904-269-0886