Healthcare Provider Details

I. General information

NPI: 1013774397
Provider Name (Legal Business Name): STACEY ANNE FARINA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9310 OLD KINGS RD S STE 701
JACKSONVILLE FL
32257-6178
US

IV. Provider business mailing address

9310 OLD KINGS RD S STE 701
JACKSONVILLE FL
32257-6178
US

V. Phone/Fax

Practice location:
  • Phone: 904-866-1857
  • Fax:
Mailing address:
  • Phone: 904-866-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: