Individual
THALIA IVETH ANYOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
590 ELLIS RD S BLDG 4, JACKSONVILLE, FL 32254-3555
(904) 800-2231
Mailing address
3500 UNIVERSITY BLVD N APT 1504, JACKSONVILLE, FL 32277-2354
(786) 440-4403
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
FL
101YM0800X
Mental Health Counselor
—
FL
Other
Enumeration date
10/12/2021
Last updated
10/12/2021
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