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General NPI Number Information
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NPI Number | 1295119618
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Entity Type | Individual
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Provider Name | ANNA RENE' MORRIS BLACKSHEAR LMHC
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Gender | Female
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 1903 ISLAND WALKWAY
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4797
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Country | US
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Telephone | 904-277-0027
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Fax | 407-867-6261
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Provider Business Mailing Address
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Address Line | 1903 ISLAND WALKWAY
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4797
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Country | US
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Telephone | 904-277-0027
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Fax | 407-867-6261
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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 | IMH12881
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License Number State | FL
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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 | MH14583
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License Number State | FL
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