Healthcare Provider Details

I. General information

NPI: 1598232258
Provider Name (Legal Business Name): HEART TOUCH CHANGE LIVES (HTCL) MINISTRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 VERNA BLVD UNIT 61446
JACKSONVILLE FL
32205-4762
US

IV. Provider business mailing address

5455 VERNA BLVD UNIT 61446
JACKSONVILLE FL
32205-4762
US

V. Phone/Fax

Practice location:
  • Phone: 904-955-5599
  • Fax:
Mailing address:
  • Phone: 904-955-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERRY R LIGHTNER
Title or Position: EXEC DIRECTOR
Credential:
Phone: 904-955-5500