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General NPI Number Information
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NPI Number | 1184237182
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Entity Type | Organization
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Legal Business Name | ANCHOR LIFE CLINIC
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 9654 RAGSDALE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6121
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Country | US
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Telephone | 904-891-9365
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Fax |
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Provider Business Mailing Address
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Address Line | 9654 RAGSDALE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6121
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Country | US
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Telephone | 904-891-9365
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELANIE MICKEY
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Credential |
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Telephone | 904-891-9365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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