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General NPI Number Information
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NPI Number | 1093854192
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL ACADEMY OF CULTURAL FREE COUNSELING AND PSYCHOTHERAPY
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2457 SOUTHERN LINKS DR
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City | ORANGE PARK
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State | FL
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Zip | 32003-6356
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Country | US
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Telephone | 904-269-4481
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Fax | 904-269-4481
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Provider Business Mailing Address
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Address Line | 2457 SOUTHERN LINKS DRIVE
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City | ORANGE PARK
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State | FL
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Zip | 32003
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Country | US
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Telephone | 904-269-4481
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Fax | 904-269-4481
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. WILLIAM CARNELL JONES
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Credential | LMHC
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Telephone | 904-269-4481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH0054
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License Number State | FL
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