Healthcare Provider Details

I. General information

NPI: 1740706647
Provider Name (Legal Business Name): REASONOVER COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 KINGSLEY LAKE DR STE 702
SAINT AUGUSTINE FL
32092-3045
US

IV. Provider business mailing address

305 KINGSLEY LAKE DR STE 702
SAINT AUGUSTINE FL
32092-3045
US

V. Phone/Fax

Practice location:
  • Phone: 904-993-0019
  • Fax: 904-993-0020
Mailing address:
  • Phone: 904-993-0019
  • Fax: 904-993-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14640
License Number StateFL

VIII. Authorized Official

Name: LORI TAYLOR REASONOVER
Title or Position: LCSW/OWNER
Credential: LCSW
Phone: 904-993-0019