Organization
SOUTHSIDE COUNSELLING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARMELLA GARDNER LMHC (OWNER)
(904) 316-3365
Entity
Organization
Contact information
Practice address
3681 CAROL ANN LN, JACKSONVILLE, FL 32223-7394
(904) 316-3365
(904) 292-2409
Mailing address
2950 HALCYON LN, JACKSONVILLE, FL 32223-6689
(904) 316-3365
(904) 292-2409
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
MH8370
FL
Other
Enumeration date
10/21/2011
Last updated
03/14/2012
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