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Organization
ETHEREAL COUNSELING CENTER LLC
Active
Organization
ETHEREAL COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA WEISS (CREDENTIALING SPECIALIST)
(904) 701-3076
Entity
Organization
Contact information
Practice address
10035 BENGAL FOX DR, JACKSONVILLE, FL 32222-2895
(904) 515-3326
Mailing address
10035 BENGAL FOX DR, JACKSONVILLE, FL 32222-2895
(904) 515-3326
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
11/10/2021
Last updated
07/24/2023
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