Individual
HARRIETTE GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
31 W ADAMS ST, STE 102, JACKSONVILLE, FL 32202-3605
(901) 338-5421
Mailing address
330 W 70TH ST, JACKSONVILLE, FL 32208-3810
(901) 338-5421
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
222Q00000X
Developmental Therapist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008048000
—
FL
Enumeration date
06/06/2007
Last updated
03/19/2020
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