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General NPI Number Information
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NPI Number | 1407400591
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Entity Type | Organization
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Legal Business Name | AUTHENTIC SELF COUNSELING OF JACKSONVILLE, LLC
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Dates
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Enumeration Date | 07/28/2019
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 7235 BENTLEY RD STE 308
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7506
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Country | US
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Telephone | 904-990-7117
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Fax |
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Provider Business Mailing Address
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Address Line | 3733 UNIVERSITY BLVD W STE 203
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2152
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Country | US
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Telephone | 904-990-7117
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE ANDERSON
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Credential |
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Telephone | 904-990-7117
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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 |
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License Number State |
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