Healthcare Provider Details

I. General information

NPI: 1205145851
Provider Name (Legal Business Name): ANNALIE SEBRIO CELZO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 SOUTHPOINT DR N STE 110
JACKSONVILLE FL
32216-8005
US

IV. Provider business mailing address

6867 SOUTHPOINT DR N STE 110
JACKSONVILLE FL
32216-8005
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-6071
  • Fax:
Mailing address:
  • Phone: 904-619-6071
  • Fax: 904-212-0309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 005772
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: