Individual
ADIA GUEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2105 PARK AVE STE 2, ORANGE PARK, FL 32073-5557
(904) 372-3070
Mailing address
7643 GATE PARKWAY SUITE 104, #828, JACKSONVILLE, FL 32256
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
26782
FL
Other
Enumeration date
11/05/2024
Last updated
11/05/2024
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