Organization
PROACTIVE LIFE SKILLS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY NODA (MANAGING DIRECTOR)
(904) 228-8358
Entity
Organization
Contact information
Practice address
13121 ATLANTIC BLVD, SUITE 200, JACKSONVILLE, FL 32225-0103
(904) 228-8358
Mailing address
13121 ATLANTIC BLVD, SUITE 200, JACKSONVILLE, FL 32225-0103
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/24/2017
Last updated
06/18/2024
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