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Organization
RIVER CITY MENTAL HEALTH COUNSELING, LLC
Active
Organization
RIVER CITY MENTAL HEALTH COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BRENT WADE JR. LMHC (OWNER)
(904) 465-1275
Entity
Organization
Contact information
Practice address
4711 US HIGHWAY 17 STE 4, FLEMING ISLAND, FL 32003-8211
(904) 465-1275
(904) 485-8359
Mailing address
308 MARISCO WAY, JACKSONVILLE, FL 32220-4608
(904) 465-1275
(904) 485-8359
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007650300
—
FL
Enumeration date
08/15/2019
Last updated
08/15/2019
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