Healthcare Provider Details

I. General information

NPI: 1639720428
Provider Name (Legal Business Name): JADE FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 CHURCH STREET SUITE 16AB SECOND FLOOR
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

PO BOX 7881
CHRISTIANSTED VI
00823-7881
US

V. Phone/Fax

Practice location:
  • Phone: 404-402-1800
  • Fax:
Mailing address:
  • Phone: 404-402-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ZULIMA WEBSTER
Title or Position: OWNER
Credential: LMFT, CAMS
Phone: 404-402-1800