Healthcare Provider Details

I. General information

NPI: 1457739609
Provider Name (Legal Business Name): FIRST STEP COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 PASEO REYES DRIVE
ST AUGUSTINE FL
32095
US

IV. Provider business mailing address

264 PASEO REYES DRIVE
ST AUGUSTINE FL
32095
US

V. Phone/Fax

Practice location:
  • Phone: 904-610-6276
  • Fax: 904-512-0474
Mailing address:
  • Phone: 904-610-6276
  • Fax: 904-512-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5716
License Number StateFL

VIII. Authorized Official

Name: MRS. SUSAN PATRICIA CAPITANO
Title or Position: OWNER
Credential: LMHC
Phone: 904-610-6276