Provider Demographics
NPI:1245562644
Name:MOMENTUM COUNSELING
Entity Type:Organization
Organization Name:MOMENTUM COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIRITO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-874-9760
Mailing Address - Street 1:320 1ST ST N STE 613
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6947
Mailing Address - Country:US
Mailing Address - Phone:904-874-9760
Mailing Address - Fax:
Practice Address - Street 1:320 1ST ST N STE 613
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-6947
Practice Address - Country:US
Practice Address - Phone:904-874-9760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9543104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCV036AMedicare PIN