Healthcare Provider Details

I. General information

NPI: 1518019710
Provider Name (Legal Business Name): PAULA JANE GRIFFIN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA JANE FOOTE

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 HENDRICKS AVENUE
JACKSONVILLE FL
32207
US

IV. Provider business mailing address

3601 HENDRICKS AVENUE
JACKSONVILLE FL
32207
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-2666
  • Fax: 904-396-2698
Mailing address:
  • Phone: 904-396-2666
  • Fax: 904-396-2698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: