Healthcare Provider Details

I. General information

NPI: 1598005456
Provider Name (Legal Business Name): JOSEPH C ROY LMHC, CAP, ICADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 ELEVENTH ST
ST AUGUSTINE FL
32084-1474
US

IV. Provider business mailing address

409 ELEVENTH ST
ST AUGUSTINE FL
32084-1474
US

V. Phone/Fax

Practice location:
  • Phone: 904-347-4162
  • Fax: 904-209-5132
Mailing address:
  • Phone: 904-347-4162
  • Fax: 904-209-5132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3138
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: