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General NPI Number Information
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NPI Number | 1568370260
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Entity Type | Individual
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Provider Name | PETER AGDAMAG JR.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 87003 PROFESSIONAL WAY
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City | YULEE
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State | FL
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Zip | 32097-3400
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Country | US
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Telephone | 904-849-1190
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Fax |
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Provider Business Mailing Address
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Address Line | 227 W LAUREL BLF
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City | KINGSLAND
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State | GA
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Zip | 31548-6183
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Country | US
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Telephone | 919-426-6886
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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 | IMH29543
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License Number State | FL
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