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General NPI Number Information
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NPI Number | 1063097269
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Entity Type | Organization
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Legal Business Name | LAKE AREA COUNSELING, LLC
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 09/25/2021
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Provider Practice Location Address
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Address Line | 950-23 BLANDING BLVD. #221
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City | ORANGE PARK
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State | FL
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Zip | 32065
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Country | US
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Telephone | 904-853-0791
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Fax |
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Provider Business Mailing Address
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Address Line | 950-23 BLANDING BLVD. #221
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City | ORANGE PARK
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State | FL
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Zip | 32065
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Country | US
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Telephone | 904-853-0791
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN HILL
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Credential | LCSW
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Telephone | 904-853-0791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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