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General NPI Number Information
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NPI Number | 1457603060
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Entity Type | Organization
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Legal Business Name | FIVE S.T.A.R. VETERANS CENTER, INC
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 40 ACME ST
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City | JACKSONVILLE
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State | FL
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Zip | 32211
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Country | US
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Telephone | 904-723-5950
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Fax | 904-723-5952
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Provider Business Mailing Address
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Address Line | 40 ACME ST
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City | JACKSONVILLE
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State | FL
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Zip | 32211-7953
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Country | US
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Telephone | 904-723-5950
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Fax | 904-723-5952
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Authorized Official
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Title or Position | STAFF THERAPIST
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Name | MR. DENNIS NELSON CAIN
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Credential | LMFT
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Telephone | 904-723-5950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | FL
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