Healthcare Provider Details

I. General information

NPI: 1023989688
Provider Name (Legal Business Name): KATIE MIGNON RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 CAMINHA RD
SAINT AUGUSTINE FL
32084-0056
US

IV. Provider business mailing address

76 CAMINHA RD
SAINT AUGUSTINE FL
32084-0056
US

V. Phone/Fax

Practice location:
  • Phone: 904-788-6878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH26409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: