Healthcare Provider Details

I. General information

NPI: 1811707623
Provider Name (Legal Business Name): PONTE VEDRA COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 VISTA LAKE CIR
PONTE VEDRA BEACH FL
32081-0080
US

IV. Provider business mailing address

130 CORRIDOR RD UNIT 266
PONTE VEDRA BEACH FL
32004-7711
US

V. Phone/Fax

Practice location:
  • Phone: 904-834-9024
  • Fax:
Mailing address:
  • Phone: 904-834-9024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY IRELAND
Title or Position: OWNER/COUNSELOR
Credential: LMHC, LMFT, LPC
Phone: 904-834-9024