Organization
RIVER CITY MENTAL HEALTH COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BRENT WADE JR. LMHC (OWNER)
(904) 465-1275
Entity
Organization
Contact information
Practice address
4711 US HIGHWAY 17 STE 4, FLEMING ISLAND, FL 32003-8211
(904) 465-1275
(904) 485-8359
Mailing address
308 MARISCO WAY, JACKSONVILLE, FL 32220-4608
(904) 465-1275
(904) 485-8359
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007650300
—
FL
Enumeration date
08/15/2019
Last updated
08/15/2019
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