Provider Demographics
NPI:1659081818
Name:KILGORE, AUDREY W (BS, TCM, MMHC, CCC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:W
Last Name:KILGORE
Suffix:
Gender:F
Credentials:BS, TCM, MMHC, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 TREE STAND CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32234-3068
Mailing Address - Country:US
Mailing Address - Phone:904-626-0115
Mailing Address - Fax:
Practice Address - Street 1:2140 KINGSLEY AVE STE 2
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5129
Practice Address - Country:US
Practice Address - Phone:904-579-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health