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General NPI Number Information
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NPI Number | 1083834246
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Entity Type | Organization
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Legal Business Name | WILLIAM L ROSS
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 1405 PARK AVE SUITE 202
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1950
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Country | US
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Telephone | 904-277-2052
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Fax | 904-277-2083
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Provider Business Mailing Address
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Address Line | 1405 PARK AVE SUITE 202
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1950
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Country | US
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Telephone | 904-277-2052
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Fax | 904-277-2083
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | WILLIAM L ROSS
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Credential | PH.D.
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Telephone | 904-277-2052
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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 | MH6579
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY4456
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY2557
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW6913
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | PY2557
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License Number State | FL
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