Healthcare Provider Details

I. General information

NPI: 1194617720
Provider Name (Legal Business Name): ONE HEALING PATHWAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 BLANDING BLVD STE 104
JACKSONVILLE FL
32210-1945
US

IV. Provider business mailing address

4703 PINE LAKE DR
MIDDLEBURG FL
32068-8725
US

V. Phone/Fax

Practice location:
  • Phone: 904-930-1972
  • Fax:
Mailing address:
  • Phone: 904-930-1972
  • 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: DR. BRIDGETTE STACEY RODRIGUEZ
Title or Position: CEO
Credential:
Phone: 904-930-1972