Healthcare Provider Details

I. General information

NPI: 1164570859
Provider Name (Legal Business Name): LINDA MARY WILLSON L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/15/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 SOUTHSIDE BLVD. APT. 1213
JACKSONVILLE FL
32256-8497
US

IV. Provider business mailing address

8700 SOUTHSIDE BLVD. APT. 1213
JACKSONVILLE FL
32256-8497
US

V. Phone/Fax

Practice location:
  • Phone: 904-538-9418
  • Fax:
Mailing address:
  • Phone: 904-538-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 0002487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: