Healthcare Provider Details

I. General information

NPI: 1679408025
Provider Name (Legal Business Name): PROF. BENJAMIN C OKAFOR SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6639 SOUTHPOINT PKWY STE 10B
JACKSONVILLE FL
32216-8041
US

IV. Provider business mailing address

4633 SILVERTHORN DR
JACKSONVILLE FL
32258-2010
US

V. Phone/Fax

Practice location:
  • Phone: 904-596-1716
  • Fax:
Mailing address:
  • Phone: 904-456-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: