Healthcare Provider Details

I. General information

NPI: 1053917922
Provider Name (Legal Business Name): JOANNE JEAN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7437 LAURA ST N
JACKSONVILLE FL
32208-4117
US

IV. Provider business mailing address

7437 LAURA ST N
JACKSONVILLE FL
32208-4117
US

V. Phone/Fax

Practice location:
  • Phone: 813-965-7645
  • Fax:
Mailing address:
  • Phone: 813-965-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JOANNE JEAN
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 352-234-3208