Healthcare Provider Details

I. General information

NPI: 1184348757
Provider Name (Legal Business Name): CAROLYN ALICE ZIMINSKI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 HAMPTON POINT DR STE 2
ST AUGUSTINE FL
32092-3119
US

IV. Provider business mailing address

7795 COLEE COVE RD
ST AUGUSTINE FL
32092-2301
US

V. Phone/Fax

Practice location:
  • Phone: 904-885-6343
  • Fax:
Mailing address:
  • Phone: 904-885-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21295
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: