Healthcare Provider Details

I. General information

NPI: 1295769602
Provider Name (Legal Business Name): HOPE HAVEN ASSOCIATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BEACH BLVD.
JACKSONVILLE FL
32207
US

IV. Provider business mailing address

4600 BEACH BLVD.
JACKSONVILLE FL
32207
US

V. Phone/Fax

Practice location:
  • Phone: 904-346-5100
  • Fax: 904-346-5111
Mailing address:
  • Phone: 904-346-5100
  • Fax: 904-346-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: STELLA JOHNSON
Title or Position: CHIEF EXECUTIVE OFFICE
Credential:
Phone: 904-346-5100