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Organization
KALENA SMITH-FULWILEY, LLC
Active
Organization
KALENA SMITH-FULWILEY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KALENA SMITH-FULWILEY LMHC (OWNER)
(904) 476-9064
Entity
Organization
Contact information
Practice address
422 NEW BERLIN RD, JACKSONVILLE, FL 32218-3827
(904) 269-0886
Mailing address
15597 SPOTTED SADDLE CIR, JACKSONVILLE, FL 32218-7984
(904) 476-9064
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH12125
FL
251S00000X
Community/Behavioral Health Agency
MH12125
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010404400
—
FL
Enumeration date
02/16/2017
Last updated
02/16/2017
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