Healthcare Provider Details

I. General information

NPI: 1588073910
Provider Name (Legal Business Name): CIPRIANO&JOHNSON COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 ISABELLA BLVD SUITE 30
JACKSONVILLE BEACH FL
32250-4099
US

IV. Provider business mailing address

2602 ISABELLA BLVD SUITE 30
JACKSONVILLE BEACH FL
32250-4099
US

V. Phone/Fax

Practice location:
  • Phone: 904-372-4349
  • Fax: 904-595-5628
Mailing address:
  • Phone: 904-372-4349
  • Fax: 904-595-5628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0416AD889502
License Number StateFL

VIII. Authorized Official

Name: MR. STEPHEN A JOHNSON
Title or Position: CFO
Credential: MS, LPC, CAP
Phone: 904-503-2634