Healthcare Provider Details

I. General information

NPI: 1649675687
Provider Name (Legal Business Name): ORGANIZATIONAL MANAGEMENT SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 KINGSLEY AVE STE 112
ORANGE PARK FL
32073-4536
US

IV. Provider business mailing address

1532 KINGSLEY AVE STE 112
ORANGE PARK FL
32073-4536
US

V. Phone/Fax

Practice location:
  • Phone: 904-214-3222
  • Fax:
Mailing address:
  • Phone: 904-214-3222
  • Fax: 904-621-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9011
License Number StateFL

VIII. Authorized Official

Name: MRS. CHRISTINA MARIE ST.CLAIR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 904-254-0332