Provider Demographics
NPI:1679012439
Name:HAYDON-DAVIS COUNSELING, INC.
Entity Type:Organization
Organization Name:HAYDON-DAVIS COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-716-5619
Mailing Address - Street 1:PO BOX 600003
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32260-0003
Mailing Address - Country:US
Mailing Address - Phone:904-716-5619
Mailing Address - Fax:248-751-5913
Practice Address - Street 1:305 KINGSLEY LAKE DR
Practice Address - Street 2:SUITE 702
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3043
Practice Address - Country:US
Practice Address - Phone:904-716-5619
Practice Address - Fax:248-751-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW76771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty