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General NPI Number Information
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NPI Number | 1316105091
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Entity Type | Organization
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Legal Business Name | DANIEL MEMORIAL INC
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 3725 BELFORT RD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5813
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Country | US
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Telephone | 904-296-1055
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Fax | 904-448-7700
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Provider Business Mailing Address
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Address Line | 3725 BELFORT RD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5813
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Country | US
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Telephone | 904-296-1055
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Fax | 904-448-7700
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. HARRY W. WILLIAMS JR.
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Credential | LMHC
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Telephone | 904-296-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH4894
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License Number State | FL
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