Healthcare Provider Details

I. General information

NPI: 1821843822
Provider Name (Legal Business Name): REBECCA H DOWNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 202A
ST AUGUSTINE FL
32080-3111
US

IV. Provider business mailing address

48 MARSHVIEW DR FL 32080
ST AUGUSTINE FL
32080-9184
US

V. Phone/Fax

Practice location:
  • Phone: 904-896-6339
  • Fax:
Mailing address:
  • Phone: 703-309-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH26593
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: