Healthcare Provider Details

I. General information

NPI: 1538158886
Provider Name (Legal Business Name): ST JOHNS COUNTY BOARD OF COUNTY COMMISSIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 US HIGHWAY 1 S SUITE C-2
ST AUGUSTINE FL
32086-3708
US

IV. Provider business mailing address

1955 US HIGHWAY 1 S SUITE C-2
ST AUGUSTINE FL
32086-3708
US

V. Phone/Fax

Practice location:
  • Phone: 904-209-6001
  • Fax: 904-209-6002
Mailing address:
  • Phone: 904-209-6001
  • Fax: 904-209-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARIA COLAVITO
Title or Position: HEALTH & HUMAN SERVICES DIRECTOR
Credential: PHD
Phone: 904-209-6082