Healthcare Provider Details

I. General information

NPI: 1013461946
Provider Name (Legal Business Name): REYLIUS THOMPSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2392 EDGEWOOD AVE N
JACKSONVILLE FL
32254-1725
US

IV. Provider business mailing address

2392 EDGEWOOD AVE N
JACKSONVILLE FL
32254-1725
US

V. Phone/Fax

Practice location:
  • Phone: 904-781-7797
  • Fax: 904-781-8685
Mailing address:
  • Phone: 904-781-7797
  • Fax: 904-781-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: