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General NPI Number Information
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NPI Number | 1689279721
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Entity Type | Organization
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Legal Business Name | HEALING BAR
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 6050 WINDING BRIDGE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32277-1441
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Country | US
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Telephone | 904-323-1146
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11394
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City | JACKSONVILLE
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State | FL
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Zip | 32239-1394
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Country | US
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Telephone | 904-323-1146
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SINADIA ELILSE GAILYARD
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Credential | LMHC
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Telephone | 904-608-0013
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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 |
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License Number State |
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