Organization
MINDFUL MEDICINE COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROMAN CRIOLLO MD (COO)
(217) 480-7298
Entity
Organization
Contact information
Practice address
10365 HOOD RD S STE 204, JACKSONVILLE, FL 32257-3261
(217) 480-7298
Mailing address
3914 DYLAN CT, JACKSONVILLE, FL 32223-2707
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118398900
—
FL
01
—
1699834408
NPI NUMBER
FL
Enumeration date
04/12/2023
Last updated
11/11/2023
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