Healthcare Provider Details

I. General information

NPI: 1730688995
Provider Name (Legal Business Name): TINA ADRIANNA SCANNELL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463142 STATE ROAD 200
YULEE FL
32097-5554
US

IV. Provider business mailing address

322 BROOKLET CIR
SAINT MARYS GA
31558-9061
US

V. Phone/Fax

Practice location:
  • Phone: 904-225-8280
  • Fax:
Mailing address:
  • Phone: 631-742-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: