Organization
AVANTI WELLNESS CENTER FLLLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RANDI B BRAZER LCSW (DIRECTOR OF OPERATIONS)
(904) 797-3115
Entity
Organization
Contact information
Practice address
3574 US 1 S, SUITE 113, ST AUGUSTINE, FL 32086-6466
(904) 797-3115
(904) 797-2915
Mailing address
3574 US 1 S, SUITE 113, ST AUGUSTINE, FL 32086-6466
(904) 797-3115
(904) 797-2915
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
207Q00000X
Family Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001136300
—
FL
Enumeration date
03/25/2009
Last updated
05/19/2011
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