MEDICARE: MISS CAROL A VISCONTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist
2	101YM0800X	Mental Health Counselor	MH13641	FL

General Provider Information

NPI Number	:	1285868141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CAROL A VISCONTI

Provider Business Mailing Address
First Line	:	PO BOX 748519
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8519
Country	:	US
Telephone Number	:	904-376-3800
Fax Number	:	904-376-3998

Provider Business Practice Location Address
First Line	:	1747 BAPTIST CLAY DR
Second Line	:	SUITE 350
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8502
Country	:	US
Telephone Number	:	904-376-3800
Fax Number	:	904-396-8966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	08/05/2022

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Directions to “ MISS CAROL A VISCONTI ” Practice Location

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