Individual
BLAIR EVONNE SHANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3725 BELFORT RD, JACKSONVILLE, FL 32216-5813
(904) 296-1055
Mailing address
3725 BELFORT RD, JACKSONVILLE, FL 32216-5813
(904) 296-1055
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
IMH26957
FL
Other
Enumeration date
01/08/2024
Last updated
02/14/2025
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