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General NPI Number Information
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NPI Number | 1124441175
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Entity Type | Organization
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Legal Business Name | JANET D. CONSTANTINE PL
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 9822 TAPESTRY PARK CIR SUITE 206
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City | JACKSONVILLE
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State | FL
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Zip | 32246-9258
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Country | US
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Telephone | 904-637-1708
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Fax | 904-207-7897
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Provider Business Mailing Address
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Address Line | 9822 TAPESTRY PARK CIR SUITE 206
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City | JACKSONVILLE
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State | FL
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Zip | 32246-9258
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Country | US
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Telephone | 904-637-1708
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Fax | 904-207-7897
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANET DIANNE CONSTANTINE
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Credential | LMHC CET II
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Telephone | 904-637-1708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH 3146
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License Number State | FL
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