Organization
AVANTI WELLNESS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENISE R ODOM (OFFICE MANAGER)
(904) 824-7597
Entity
Organization
Contact information
Practice address
165 SOUTHPARK BLVD, SUITE D, ST AUGUSTINE, FL 32086-4101
(904) 824-7597
(904) 824-7598
Mailing address
165 SOUTHPARK BLVD, SUITE D, ST AUGUSTINE, FL 32086-4101
(904) 824-7597
(904) 824-7598
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103TC0700X
Clinical Psychologist
PY7098
FL
1041C0700X
Clinical Social Worker
SW5151
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC7024
MEDICAL LICENSE NUMBER
FL
Enumeration date
08/11/2006
Last updated
09/11/2025
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