Provider Demographics
NPI:1811187271
Name:MANDARIN COUNSELING INC
Entity Type:Organization
Organization Name:MANDARIN COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-260-0454
Mailing Address - Street 1:12058 SAN JOSE BLVD
Mailing Address - Street 2:STE 703
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-260-0454
Mailing Address - Fax:904-260-0044
Practice Address - Street 1:12058 SAN JOSE BLVD
Practice Address - Street 2:STE 703
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8666
Practice Address - Country:US
Practice Address - Phone:904-260-0454
Practice Address - Fax:904-260-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW66891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty