Healthcare Provider Details

I. General information

NPI: 1942846274
Provider Name (Legal Business Name): KRISTIN RISPOLI COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12443 SAN JOSE BLVD STE 202
JACKSONVILLE FL
32223-8648
US

IV. Provider business mailing address

12443 SAN JOSE BLVD STE 202
JACKSONVILLE FL
32223-8648
US

V. Phone/Fax

Practice location:
  • Phone: 352-255-4628
  • 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 State

VIII. Authorized Official

Name: KRISTIN RISPOLI
Title or Position: CEO
Credential:
Phone: 352-255-4628