Provider Demographics
NPI:1417373838
Name:JACKSONVILLE CENTER FOR SEXUAL HEALTH, LLC
Entity Type:Organization
Organization Name:JACKSONVILLE CENTER FOR SEXUAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:POMEROY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-383-7613
Mailing Address - Street 1:1637 RACE TRACK RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3239
Mailing Address - Country:US
Mailing Address - Phone:904-383-7613
Mailing Address - Fax:
Practice Address - Street 1:1637 RACE TRACK RD
Practice Address - Street 2:SUITE 225
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3239
Practice Address - Country:US
Practice Address - Phone:904-383-7613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty