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General NPI Number Information
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NPI Number | 1114173663
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Entity Type | Organization
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Legal Business Name | IN-TRINSIC, INC.
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 2342 PARK ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4318
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Country | US
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Telephone | 904-384-4910
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Fax | 904-389-9220
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Provider Business Mailing Address
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Address Line | 2342 PARK ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4318
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Country | US
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Telephone | 904-384-4910
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Fax | 904-389-9220
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHY A. WHITAKER
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Credential | LMHC
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Telephone | 904-384-4910
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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 | 2154
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License Number State | FL
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