Organization
KOINONIA DYNAMIS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ADDRIS BLANCHE VINSON LMHC, CRC (CEO)
(904) 354-6005
Entity
Organization
Contact information
Practice address
1734 HIRAM ST, JACKSONVILLE, FL 32209-6105
(904) 354-6005
(904) 354-6005
Mailing address
1734 HIRAM ST, JACKSONVILLE, FL 32209-6105
(904) 354-6005
(904) 354-6005
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
MH9044
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285766840
—
FL
Enumeration date
04/27/2009
Last updated
04/27/2009
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