MEDICARE: TELE-MARLYS ADJEVI-NEGLOKPE

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	101YM0800X	Mental Health Counselor	MH22099	FL

General Provider Information

NPI Number	:	1477249803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TELE-MARLYS ADJEVI-NEGLOKPE

Provider Business Mailing Address
First Line	:	11485 FORT CAROLINE LAKES DR N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-2575
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10163 FORTUNE PKWY STE G20
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3519
Country	:	US
Telephone Number	:	904-257-3672
Fax Number	:

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

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/01/2025

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Directions to “ TELE-MARLYS ADJEVI-NEGLOKPE ” Practice Location

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