MEDICARE: VIRGIE JADE STONE 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		FL

General Provider Information

NPI Number	:	1922850981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGIE JADE STONE LMHC

Provider Business Mailing Address
First Line	:	7777 NORMANDY BLVD APT 212
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-7661
Country	:	US
Telephone Number	:	904-982-5666
Fax Number	:

Provider Business Practice Location Address
First Line	:	5960 BEACH BLVD STE 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5113
Country	:	US
Telephone Number	:	904-701-0229
Fax Number	:

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

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/03/2024

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