Provider Demographics
NPI:1033462163
Name:POSITIVE CHANGE MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:POSITIVE CHANGE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KNABB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-383-7352
Mailing Address - Street 1:9771 RIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32220-1919
Mailing Address - Country:US
Mailing Address - Phone:904-383-7352
Mailing Address - Fax:904-404-7740
Practice Address - Street 1:6620 SOUTHPOINT DR S STE 450F
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0912
Practice Address - Country:US
Practice Address - Phone:904-383-7352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8463103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty