Healthcare Provider Details

I. General information

NPI: 1588319784
Provider Name (Legal Business Name): VIRGIN ISLANDS AGENCY FOR RESTORATIVE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4204 ANNAS RETREAT
ST THOMAS VI
00802-1765
US

IV. Provider business mailing address

15770 STEDMAN LAKE DR
JACKSONVILLE FL
32218-0619
US

V. Phone/Fax

Practice location:
  • Phone: 904-554-2185
  • Fax: 888-402-9512
Mailing address:
  • Phone: 904-554-2185
  • Fax: 888-402-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. GAIL JAMES
Title or Position: FOUNDER/CHAIRMAN
Credential: PHD.
Phone: 904-554-2185