Healthcare Provider Details

I. General information

NPI: 1255245023
Provider Name (Legal Business Name): COUNSELING CENTERS OF AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5874 SANDSTONE WAY
JACKSONVILLE FL
32258-5417
US

IV. Provider business mailing address

1604 FENTON AVE
SAINT JOHNS FL
32259-7288
US

V. Phone/Fax

Practice location:
  • Phone: 833-825-5588
  • Fax:
Mailing address:
  • Phone: 833-825-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SABRINA AHMED
Title or Position: CO-OWNER
Credential: LMHC
Phone: 833-825-5588