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General NPI Number Information
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NPI Number | 1760850200
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Entity Type | Organization
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Legal Business Name | JENNIFER ANN COUNSELING OF FLORIDA LLC
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 1409 KINGSLEY AVE STE 9E
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City | ORANGE PARK
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State | FL
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Zip | 32073-4579
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Country | US
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Telephone | 904-215-4151
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Fax |
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Provider Business Mailing Address
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Address Line | 1956 HARBOR ISLAND DR
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-7257
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Country | US
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Telephone | 904-651-2490
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER ANN DAHL
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Credential | MS, CRC, LMHC
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Telephone | 904-651-2490
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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 | MH 6933
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License Number State | FL
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