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General NPI Number Information
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NPI Number | 1710243571
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Entity Type | Organization
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Legal Business Name | CENTER FOR A HEALTHY MIND AND WELLBEING LLC
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 6817 SOUTHPOINT PKWY STE 1301
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6297
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Country | US
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Telephone | 904-527-8777
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Fax | 904-379-5744
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Provider Business Mailing Address
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Address Line | 1677 WELLS RD SUITE A
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City | ORANGE PARK
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State | FL
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Zip | 32073-6799
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Country | US
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Telephone | 904-272-0043
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Fax | 904-272-0045
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | GINGER HUDNALL
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Credential |
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Telephone | 904-527-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME108768
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License Number State | FL
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