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General NPI Number Information
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NPI Number | 1578969796
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Entity Type | Organization
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Legal Business Name | ARVENSIS THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 11/16/2014
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Last Update Date | 11/16/2014
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Provider Practice Location Address
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Address Line | 2155 BELOTE PL
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City | JACKSONVILLE
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State | FL
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Zip | 32207-3363
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Country | US
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Telephone | 904-868-2182
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Fax |
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Provider Business Mailing Address
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Address Line | 2768 SOUTHWOOD LN
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City | JACKSONVILLE
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State | FL
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Zip | 32207-4130
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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 | LINDA F LATIMER
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Credential | LMHC
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Telephone | 904-868-2182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH12959
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License Number State | FL
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