Organization
THERESA COUNCIL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA COUNCIL (OWNER)
(904) 355-6864
Entity
Organization
Contact information
Practice address
2815 MELSON AVE, JACKSONVILLE, FL 32254-1853
(904) 355-6864
Mailing address
2815 MELSON AVE, JACKSONVILLE, FL 32254-1853
(904) 355-6864
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
Other
Enumeration date
09/13/2018
Last updated
06/30/2019
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