Healthcare Provider Details

I. General information

NPI: 1346996477
Provider Name (Legal Business Name): AMD COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 HAMILTON ST STE 108
JACKSONVILLE FL
32210-2077
US

IV. Provider business mailing address

4530 SAINT JOHNS AVE STE 15-214
JACKSONVILLE FL
32210-1852
US

V. Phone/Fax

Practice location:
  • Phone: 904-419-9864
  • Fax: 904-212-0929
Mailing address:
  • Phone: 904-419-9864
  • Fax: 904-212-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. ALLISON DEMPSEY
Title or Position: CEO
Credential: LMHC, BCBA
Phone: 904-419-9864