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General NPI Number Information
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NPI Number | 1780393553
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Entity Type | Organization
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Legal Business Name | COMMUNITY MENTAL HEALTH SERVICES CENTER
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 2799 KIOWA AVE
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City | ORANGE PARK
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State | FL
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Zip | 32065-7465
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Country | US
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Telephone | 346-467-8903
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Fax |
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Provider Business Mailing Address
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Address Line | 2799 KIOWA AVE
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City | ORANGE PARK
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State | FL
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Zip | 32065-7465
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Country | US
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Telephone | 346-467-8903
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/CLINICAL MANAGER
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Name | DR. HAMILTON MERILUS
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Credential | ED.D
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Telephone | 346-467-8903
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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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