# KALENA SMITH-FULWILEY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538608112
- **Authorized official:** KALENA SMITH-FULWILEY LMHC (OWNER)
- **Authorized official phone:** (904) 476-9064

## Contact information

- **Practice address:** 422 NEW BERLIN RD, JACKSONVILLE, FL 32218-3827
- **Practice address phone:** (904) 269-0886
- **Mailing address:** 15597 SPOTTED SADDLE CIR, JACKSONVILLE, FL 32218-7984
- **Mailing address phone:** (904) 476-9064

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | MH12125 | FL | Yes |
| 251S00000X | Community/Behavioral Health Agency | MH12125 | FL | — |

## Other

- **Enumeration date:** 02/16/2017
- **Last updated:** 02/16/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 010404400 | — | FL |