Healthcare Provider Details

I. General information

NPI: 1205675329
Provider Name (Legal Business Name): ITS HOLISTIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 ARLINGTON EXPY STE 109
JACKSONVILLE FL
32211-5779
US

IV. Provider business mailing address

6501 ARLINGTON EXPY STE 109
JACKSONVILLE FL
32211-5779
US

V. Phone/Fax

Practice location:
  • Phone: 904-208-0760
  • Fax:
Mailing address:
  • Phone: 904-855-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TANITHA NICHOLAS
Title or Position: CEO
Credential:
Phone: 904-208-0760