Healthcare Provider Details

I. General information

NPI: 1164309472
Provider Name (Legal Business Name): HEATHER JOHNSON RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 BAYCENTER RD
JACKSONVILLE FL
32256-7420
US

IV. Provider business mailing address

3656 CEDAR DR
JACKSONVILLE FL
32207-6851
US

V. Phone/Fax

Practice location:
  • Phone: 904-448-1933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: