Provider Demographics
NPI:1114553559
Name:PATRICK, DESIREE (LMHC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:PATRICK-MOCKALIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 1072
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067-1072
Mailing Address - Country:US
Mailing Address - Phone:904-258-2524
Mailing Address - Fax:
Practice Address - Street 1:2575 COUNTY ROAD 220 STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-6542
Practice Address - Country:US
Practice Address - Phone:904-615-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health