Provider Demographics
NPI:1710243571
Name:CENTER FOR A HEALTHY MIND AND WELLBEING LLC
Entity Type:Organization
Organization Name:CENTER FOR A HEALTHY MIND AND WELLBEING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDNALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-527-8777
Mailing Address - Street 1:1677 WELLS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-6799
Mailing Address - Country:US
Mailing Address - Phone:904-272-0043
Mailing Address - Fax:904-272-0045
Practice Address - Street 1:1677 WELLS RD
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-6799
Practice Address - Country:US
Practice Address - Phone:904-272-0043
Practice Address - Fax:904-272-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1087682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty