Provider Demographics
NPI:1508395039
Name:JAMES, GAIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15770 STEDMAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-0619
Mailing Address - Country:US
Mailing Address - Phone:904-554-2185
Mailing Address - Fax:
Practice Address - Street 1:3733 UNIVERSITY BLVD W STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2152
Practice Address - Country:US
Practice Address - Phone:904-755-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJG722437101YP1600X
FLPY7237103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811016728OtherDR. JAMES COUNSELING AND CONSULTING / HEAVENLY HOME SWEET HOME, INC.