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General NPI Number Information
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NPI Number | 1558890392
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Entity Type | Organization
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Legal Business Name | J-NISSI'S THERAPY & COUNSELING LLC
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1536 KINGSLEY AVE STE 120
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City | ORANGE PARK
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State | FL
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Zip | 32073-4525
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Country | US
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Telephone | 904-304-3800
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Fax | 904-644-7123
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Provider Business Mailing Address
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Address Line | 1536 KINGSLEY AVE STE 120
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City | ORANGE PARK
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State | FL
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Zip | 32073-4525
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Country | US
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Telephone | 904-304-3800
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Fax | 904-644-7123
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Authorized Official
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Title or Position | OWNER
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Name | MS. RENEE ANITA DUNHAM
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Credential | LMHC
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Telephone | 903-304-3800
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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 | MH11462
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License Number State | FL
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