Healthcare Provider Details

I. General information

NPI: 1831948751
Provider Name (Legal Business Name): AMBER CHASE BCCC, CCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 CLEARSKY DR
JACKSONVILLE FL
32258-8431
US

IV. Provider business mailing address

6155 CLEARSKY DR
JACKSONVILLE FL
32258-8431
US

V. Phone/Fax

Practice location:
  • Phone: 904-661-9052
  • Fax:
Mailing address:
  • Phone: 904-661-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: