Healthcare Provider Details

I. General information

NPI: 1144147638
Provider Name (Legal Business Name): MANDY JAMES MA, NCC, RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 BELLA VISTA BLVD APT 114
ST AUGUSTINE FL
32084-1298
US

IV. Provider business mailing address

1080 BELLA VISTA BLVD APT 114
ST AUGUSTINE FL
32084-1298
US

V. Phone/Fax

Practice location:
  • Phone: 904-417-8453
  • Fax:
Mailing address:
  • Phone: 904-417-8453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH-28555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: