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General NPI Number Information
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NPI Number | 1033462163
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Entity Type | Organization
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Legal Business Name | POSITIVE CHANGE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 10/26/2012
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 6620 SOUTHPOINT DR S STE 450F
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City | JACKSONVILLE
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State | FL
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Zip | 32216-0912
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Country | US
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Telephone | 904-383-7352
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Fax |
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Provider Business Mailing Address
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Address Line | 9771 RIDDLE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32220-1919
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Country | US
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Telephone | 904-383-7352
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Fax | 904-404-7740
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL DANIEL KNABB
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Credential | PHD
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Telephone | 904-383-7352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY8463
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License Number State | FL
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