MEDICARE: ANDERSON KAGEY RECOVERY

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

General Provider Information

NPI Number	:	1972304665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON KAGEY RECOVERY

Provider Business Mailing Address
First Line	:	610 S 15TH ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-2922
Country	:	US
Telephone Number	:	904-894-3867
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 3RD ST S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6033
Country	:	US
Telephone Number	:	904-894-3867
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE ANDERSON
Credential	:	LMHC, QS
Telephone Number	:	904-894-2867

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	03/20/2025

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Directions to “ANDERSON KAGEY RECOVERY ” Practice Location

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