Healthcare Provider Details

I. General information

NPI: 1457894248
Provider Name (Legal Business Name): ASHLEY NICOLE SIMPSON DE LA CRUZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/25/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 BAYCENTER RD
JACKSONVILLE FL
32256-7420
US

IV. Provider business mailing address

8540 BAYCENTER RD
JACKSONVILLE FL
32256-7420
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 NumberMH17848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: