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General NPI Number Information
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NPI Number | 1245344027
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Entity Type | Individual
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Provider Name | GEORGE MICHEAL JOSEPH JR. M.S.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1579 THE GREENS WAY SUITE 18
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-1417
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Country | US
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Telephone | 904-280-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 1579 THE GREENS WAY SUITE 18
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-1417
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Country | US
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Telephone | 904-280-3552
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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 | MH5169
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License Number State | FL
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