Healthcare Provider Details

I. General information

NPI: 1093593659
Provider Name (Legal Business Name): 1UP COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 GERONA RD
ST AUGUSTINE FL
32086
US

IV. Provider business mailing address

2465 US 1 S # 1111
ST AUGUSTINE FL
32086-6076
US

V. Phone/Fax

Practice location:
  • Phone: 904-494-8393
  • Fax:
Mailing address:
  • Phone: 904-494-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ADAMS
Title or Position: OWNER
Credential: LMHC
Phone: 904-494-8393