Healthcare Provider Details

I. General information

NPI: 1669257648
Provider Name (Legal Business Name): HEALING PAYNE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8166 HOMESTEAD OAKS DR
JACKSONVILLE FL
32221-1600
US

IV. Provider business mailing address

1601 29TH ST UNIT 1292
BOULDER CO
80301-1010
US

V. Phone/Fax

Practice location:
  • Phone: 904-577-0195
  • Fax:
Mailing address:
  • Phone: 970-610-0935
  • Fax: 303-997-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. VICTORIA L PAYNE
Title or Position: OWNER
Credential: LPC, MCAP, ICADC SAP
Phone: 904-788-7746