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General NPI Number Information
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NPI Number | 1790378826
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Entity Type | Organization
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Legal Business Name | ENE SELFCARE ESSENTIALS LLC
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 50 N LAURA ST STE 2500
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3646
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Country | US
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Telephone | 904-580-6146
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Fax | 904-782-6860
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Provider Business Mailing Address
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Address Line | 1843 MORGANA RD
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City | JACKSONVILLE
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State | FL
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Zip | 32211-4110
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Country | US
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Telephone | 904-580-6146
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Fax | 904-782-6860
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Authorized Official
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Title or Position | CEO
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Name | SHANTIZIA FIGGS
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Credential | LCSW
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Telephone | 904-580-6146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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