=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790136208
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE STRENGTHS INITIATIVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2016
-----------------------------------------------------
Last Update Date | 06/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 804 3RD ST SUITE A-B
-----------------------------------------------------
City | NEPTUNE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32266-5040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-701-2926
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 331330
-----------------------------------------------------
City | ATLANTIC BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32233-1330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-701-2926
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOANNA LEA ALE
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 904-701-2926
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH13635F
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------