Healthcare Provider Details

I. General information

NPI: 1346932332
Provider Name (Legal Business Name): DANIELLE FREE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 PELLICER LN
ST AUGUSTINE FL
32084-0491
US

IV. Provider business mailing address

1601 TWIN OAK LN
MIDDLEBURG FL
32068-3921
US

V. Phone/Fax

Practice location:
  • Phone: 904-758-8097
  • Fax:
Mailing address:
  • Phone: 904-758-8097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: