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General NPI Number Information
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NPI Number | 1629577234
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Entity Type | Individual
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Provider Name | JILL JOAN COLLIAS-GRAY
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Gender | Female
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Dates
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Enumeration Date | 02/09/2018
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 6620 SOUTHPOINT DR S STE 450-J
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City | JACKSONVILLE
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State | FL
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Zip | 32216-0901
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Country | US
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Telephone | 904-990-3955
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Fax |
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Provider Business Mailing Address
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Address Line | 4443 HANOVER PARK DR
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City | JACKSONVILLE
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State | FL
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Zip | 32224-8604
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Country | US
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Telephone | 727-481-6557
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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 | MH12779
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License Number State | FL
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