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NPI Code Detail

MEDICARE: VIRGINIA GRACE SUMNER M.ED, ED.S

MEDICARE: VIRGINIA GRACE SUMNER M.ED, ED.S
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
1101YM0800XMental Health CounselorMH18893FL
2101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922349646
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIRGINIA GRACE SUMNER M.ED, ED.S
Provider Business Mailing Address
First Line : 5776 SAINT AUGUSTINE RD # 8030
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8046
Country : US
Telephone Number : 904-258-9038
Fax Number :
Provider Business Practice Location Address
First Line : 5776 SAINT AUGUSTINE RD # 8030
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8046
Country : US
Telephone Number : 904-258-9038
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2013
Last Update Date : 04/16/2021

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Directions to “ VIRGINIA GRACE SUMNER M.ED, ED.S” Practice Location

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