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General NPI Number Information
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NPI Number | 1124493804
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Entity Type | Organization
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Legal Business Name | ESSENCE OF LIFE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 7235 BONNEVAL RD SUITE# 205
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7565
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Country | US
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Telephone | 904-699-6342
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Fax | 904-861-0441
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Provider Business Mailing Address
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Address Line | 16462 TISONS BLUFF RD
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City | JACKSONVILLE
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State | FL
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Zip | 32218-8993
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Country | US
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Telephone | 904-699-6342
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TYRENIA OCTAVIA CROSS
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Credential | LMHC
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Telephone | 904-699-6342
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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 | MH13677
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License Number State | FL
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