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General NPI Number Information
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NPI Number | 1912493917
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA MENTAL HEALTH AND WELLNESS CENTER
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 232 SW BEAUREGARD GLN
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City | LAKE CITY
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State | FL
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Zip | 32024-5013
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Country | US
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Telephone | 386-623-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 653 SW CHOCTAW AVE
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City | FORT WHITE
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State | FL
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Zip | 32038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JESSICA LAND
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Credential |
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Telephone | 386-623-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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