Provider Demographics
NPI:1598187932
Name:STEPHENS, JAMARA
Entity Type:Individual
Prefix:
First Name:JAMARA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-5596
Mailing Address - Country:US
Mailing Address - Phone:904-683-1425
Mailing Address - Fax:
Practice Address - Street 1:1225 W BEAVER ST STE 205
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204
Practice Address - Country:US
Practice Address - Phone:904-712-3540
Practice Address - Fax:904-775-3570
Is Sole Proprietor?:No
Enumeration Date:2014-01-18
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor