Provider Demographics
NPI:1558905802
Name:THE CENTER FOR INTUITIVE LIVING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:THE CENTER FOR INTUITIVE LIVING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:904-419-3907
Mailing Address - Street 1:12058 SAN JOSE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8669
Mailing Address - Country:US
Mailing Address - Phone:904-419-3907
Mailing Address - Fax:
Practice Address - Street 1:12058 SAN JOSE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8669
Practice Address - Country:US
Practice Address - Phone:904-419-3907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty