Healthcare Provider Details

I. General information

NPI: 1639943855
Provider Name (Legal Business Name): ALISHIA ALBRITTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 KINGSLEY AVE
ORANGE PARK FL
32073-4538
US

IV. Provider business mailing address

11250 JUSTIN OAKS DR
JACKSONVILLE FL
32221-3852
US

V. Phone/Fax

Practice location:
  • Phone: 904-214-3222
  • Fax:
Mailing address:
  • Phone: 321-348-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: