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General NPI Number Information
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NPI Number | 1679745921
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Entity Type | Individual
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Provider Name | SHANNON DAWN COFFEY LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 11820 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32246-6670
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Country | US
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Telephone | 904-642-9100
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Fax | 904-642-9108
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Provider Business Mailing Address
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Address Line | PO BOX 19249
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City | JACKSONVILLE
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State | FL
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Zip | 32245-9249
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Country | US
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Telephone | 904-743-1883
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Fax | 904-743-5109
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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 | MH4581
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License Number State | FL
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