Healthcare Provider Details

I. General information

NPI: 1508123647
Provider Name (Legal Business Name): CARRIE SIMPSON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 37TH AVE S
JACKSONVILLE BEACH FL
32250-5940
US

IV. Provider business mailing address

41 37TH AVE S
JACKSONVILLE BEACH FL
32250-5940
US

V. Phone/Fax

Practice location:
  • Phone: 904-993-1602
  • Fax:
Mailing address:
  • Phone: 904-993-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: