Provider Demographics
NPI:1598109357
Name:GARDNER, MINDI DAWSON (MSW, LCSW, CBHCMS)
Entity Type:Individual
Prefix:MRS
First Name:MINDI
Middle Name:DAWSON
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MSW, LCSW, CBHCMS
Other - Prefix:MRS
Other - First Name:MINDI
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11513 KINGS RIDGE CT S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8125
Mailing Address - Country:US
Mailing Address - Phone:904-489-4223
Mailing Address - Fax:
Practice Address - Street 1:11513 KINGS RIDGE CT S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8125
Practice Address - Country:US
Practice Address - Phone:904-489-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCCMS100460-A171M00000X, 251B00000X, 171M00000X
FLSW153971041C0700X, 101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health