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General NPI Number Information
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NPI Number | 1144781394
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Entity Type | Individual
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Provider Name | LYDA HOLGUIN-GAVIRIA LCPC, LMHC, NCC
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Gender | Female
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 4651 SALISBURY RD
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6107
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Country | US
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Telephone | 571-336-7952
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Fax |
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Provider Business Mailing Address
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Address Line | 4651 SALISBURY RD STE 400
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6187
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Country | US
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Telephone | 571-336-7952
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PRC15031
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH25656
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC8723
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License Number State | MD
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