Provider Demographics
NPI:1821244104
Name:WOMEN'S CENTER OF JACKSONVILLE
Entity Type:Organization
Organization Name:WOMEN'S CENTER OF JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-722-3000
Mailing Address - Street 1:5644 COLCORD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-7017
Mailing Address - Country:US
Mailing Address - Phone:904-722-3000
Mailing Address - Fax:904-722-3100
Practice Address - Street 1:5644 COLCORD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-7017
Practice Address - Country:US
Practice Address - Phone:904-722-3000
Practice Address - Fax:904-722-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4529251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health