Provider Demographics
NPI:1689279721
Name:HEALING BAR
Entity Type:Organization
Organization Name:HEALING BAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SINADIA
Authorized Official - Middle Name:ELILSE
Authorized Official - Last Name:GAILYARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-608-0013
Mailing Address - Street 1:PO BOX 11394
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-1394
Mailing Address - Country:US
Mailing Address - Phone:904-323-1146
Mailing Address - Fax:
Practice Address - Street 1:6050 WINDING BRIDGE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-1441
Practice Address - Country:US
Practice Address - Phone:904-323-1146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102318100Medicaid