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General NPI Number Information
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NPI Number | 1437674769
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Entity Type | Organization
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Legal Business Name | TRAUMA HEALING CENTER, LLC
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8825 PERIMETER PARK BLVD STE 402
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1124
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Country | US
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Telephone | 904-719-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 8825 PERIMETER PARK BLVD STE 402
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1124
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Country | US
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Telephone | 904-719-3312
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ZACHARY FLEMING
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Credential |
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Telephone | 904-894-1736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME102872
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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 | MH13530
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License Number State | FL
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