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General NPI Number Information
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NPI Number | 1164245965
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Entity Type | Organization
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Legal Business Name | FIRST COAST EVALUATION CENTER, LLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 3101 SAWGRASS VILLAGE CIR
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-5032
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Country | US
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Telephone | 904-889-0089
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Fax |
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Provider Business Mailing Address
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Address Line | 1492 LANDAU RD
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City | JACKSONVILLE
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State | FL
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Zip | 32225-8275
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | ARIANA GRAY
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Credential | ED.S., NCSP
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Telephone | 904-274-1119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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