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General NPI Number Information
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NPI Number | 1184631814
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Entity Type | Organization
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Legal Business Name | YOUR JOURNEY INC.
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9447 BRUNTSFIELD DR
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City | JACKSONVILLE
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State | FL
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Zip | 32244-7176
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Country | US
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Telephone | 904-772-6442
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Fax | 904-772-6443
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Provider Business Mailing Address
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Address Line | 9526 ARGYLE FOREST BLVD SUITE B2 PMB #309
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City | JACKSONVILLE
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State | FL
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Zip | 32222-2825
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Country | US
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Telephone | 904-772-6442
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Fax | 904-772-6443
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LISA S. BLIZZARD
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Credential | B.A.
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Telephone | 904-772-6442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | FL
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