Organization
LISA BRICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRIS MILLER (OFFICE MANAGER)
(904) 797-5680
Entity
Organization
Contact information
Practice address
248 SOUTHPARK CIRCLE EAST, SAINT AUGUSTINE, FL 32086
(904) 797-5680
Mailing address
248 SOUTHPARK CIR E, SAINT AUGUSTINE, FL 32086-5137
(904) 797-5680
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW13171
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548715329
NPI
FL
Enumeration date
12/06/2016
Last updated
12/06/2016
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