Healthcare Provider Details

I. General information

NPI: 1548958168
Provider Name (Legal Business Name): RIVER'S EDGE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 CLAIRE LN STE 202
JACKSONVILLE FL
32223-6665
US

IV. Provider business mailing address

43 KNIGHT BOXX RD STE 1
ORANGE PARK FL
32065-7395
US

V. Phone/Fax

Practice location:
  • Phone: 904-379-8675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMANDA HANNAH
Title or Position: OWNER
Credential:
Phone: 904-379-8675