Provider Demographics
NPI:1508855560
Name:ST JOHNS COUNTY BOARD OF COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:ST JOHNS COUNTY BOARD OF COUNTY COMMISSIONERS
Other - Org Name:ST JOHNS COUNTY MENTAL HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH & HUMAN SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLAVITO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-209-6082
Mailing Address - Street 1:1955 US HIGHWAY 1 S
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3708
Mailing Address - Country:US
Mailing Address - Phone:904-209-6001
Mailing Address - Fax:904-209-6002
Practice Address - Street 1:1955 US HIGHWAY 1 S
Practice Address - Street 2:SUITE C-2
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3708
Practice Address - Country:US
Practice Address - Phone:904-209-6001
Practice Address - Fax:904-209-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health