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General NPI Number Information
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NPI Number | 1558068379
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Entity Type | Individual
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Provider Name | GEORGE JAMES MENDES M.A, M.DIV., D.MIN
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Gender | Male
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 4375 US HIGHWAY 17 STE 103
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4832
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Country | US
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Telephone | 904-269-0886
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Fax |
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Provider Business Mailing Address
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Address Line | 2646 KERMIT CT
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City | ORANGE PARK
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State | FL
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Zip | 32065-7682
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Country | US
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Telephone | 619-565-9650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MH21871
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License Number State | FL
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