Healthcare Provider Details

I. General information

NPI: 1770988719
Provider Name (Legal Business Name): SABRINA CONNELLY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PASEO REYES DR
SAINT AUGUSTINE FL
32095-8462
US

IV. Provider business mailing address

390 SAMARA LAKES PKWY
SAINT AUGUSTINE FL
32092-1937
US

V. Phone/Fax

Practice location:
  • Phone: 904-419-9189
  • Fax: 904-456-0852
Mailing address:
  • Phone: 904-625-3162
  • Fax: 904-456-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: