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General NPI Number Information
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NPI Number | 1013170844
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Entity Type | Organization
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Legal Business Name | PEGGI S WEGENER EDS INC
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 2950 HALCYON LN STE 204
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City | JACKSONVILLE
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State | FL
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Zip | 32223-6690
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Country | US
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Telephone | 904-262-1900
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Fax | 904-262-1905
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Provider Business Mailing Address
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Address Line | 2950 HALCYON LN STE 204
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City | JACKSONVILLE
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State | FL
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Zip | 32223-6690
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Country | US
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Telephone | 904-262-1900
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Fax | 904-262-1905
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. PEGGI SANBORN WEGENER
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Credential | LMHC, NCC, BCPCC
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Telephone | 904-262-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH0003102
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License Number State | FL
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