MEDICARE: HEATHER DONICA LMHC

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	16669	FL

General Provider Information

NPI Number	:	1528600087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER DONICA LMHC

Provider Business Mailing Address
First Line	:	3800 W BROWARD BLVD STE 100
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-1018
Country	:	US
Telephone Number	:	954-587-1008
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 CORPORATE SQUARE BLVD STE 124A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1977
Country	:	US
Telephone Number	:	813-443-4827
Fax Number	:

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

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	10/16/2019

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Directions to “ HEATHER DONICA LMHC” Practice Location

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