Healthcare Provider Details

I. General information

NPI: 1710606389
Provider Name (Legal Business Name): ATIYA LOVETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ATIYA MASON

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 BAYCENTER RD
JACKSONVILLE FL
32256-7420
US

IV. Provider business mailing address

1865 WELLS RD APT 257
ORANGE PARK FL
32073-6711
US

V. Phone/Fax

Practice location:
  • Phone: 904-448-1933
  • Fax:
Mailing address:
  • Phone: 864-325-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberISW14890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: