Healthcare Provider Details

I. General information

NPI: 1396526257
Provider Name (Legal Business Name): AHAVAH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 KINGSLEY AVE # 170
ORANGE PARK FL
32073-4507
US

IV. Provider business mailing address

1335 KINGSLEY AVE # 170
ORANGE PARK FL
32073-4507
US

V. Phone/Fax

Practice location:
  • Phone: 904-878-9087
  • Fax:
Mailing address:
  • Phone: 904-878-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. JACQUELINE N GAMBLE
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 904-878-9087