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General NPI Number Information
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NPI Number | 1336683663
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Entity Type | Organization
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Legal Business Name | LISA BRICE
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 248 SOUTHPARK CIRCLE EAST
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086
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Country | US
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Telephone | 904-797-5680
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Fax |
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Provider Business Mailing Address
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Address Line | 248 SOUTHPARK CIR E
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-5137
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Country | US
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Telephone | 904-797-5680
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRIS MILLER
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Credential |
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Telephone | 904-797-5680
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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 | SW13171
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License Number State | FL
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