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General NPI Number Information
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NPI Number | 1356137699
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Entity Type | Organization
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Legal Business Name | JACQUELINE M RITA LMHC LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 211 E INTERNATIONAL SPEEDWAY BLVD STE 107
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-4662
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Country | US
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Telephone | 401-486-6081
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Fax | 386-401-2414
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Provider Business Mailing Address
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Address Line | 1225 RUTHBERN RD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5961
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Country | US
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Telephone | 401-486-6081
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Fax | 386-401-2414
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JACQUELINE M RITA
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Credential | LMHC
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Telephone | 401-486-6081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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