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General NPI Number Information
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NPI Number | 1508437773
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Entity Type | Organization
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Legal Business Name | WILDFLOWERS & WEEDS
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 4110 SOUTHPOINT BLVD STE 116
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City | JACKSONVILLE
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State | FL
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Zip | 32216-0925
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Country | US
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Telephone | 904-325-9155
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Fax |
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Provider Business Mailing Address
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Address Line | 13245 ATLANTIC BLVD STE 4-243
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City | JACKSONVILLE
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State | FL
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Zip | 32225-7121
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. AMANDA FORREST
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Credential | LCSW
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Telephone | 904-325-9155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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