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General NPI Number Information
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NPI Number | 1144717497
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Entity Type | Organization
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Legal Business Name | SURRENDERING MINDS LLC
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Dates
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Enumeration Date | 04/21/2018
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Last Update Date | 04/21/2018
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Provider Practice Location Address
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Address Line | 11627 HICKORY OAK DR
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City | JACKSONVILLE
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State | FL
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Zip | 32218-9078
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Country | US
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Telephone | 904-316-4420
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Fax |
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Provider Business Mailing Address
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Address Line | 11627 HICKORY OAK DR
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City | JACKSONVILLE
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State | FL
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Zip | 32218-9078
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Country | US
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Telephone | 904-316-4420
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | LAUREN ANTHONY
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Credential | LCSW
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Telephone | 904-316-4420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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