Provider Demographics
NPI:1932510823
Name:AVENT, JACK JR (MA, CAP)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:AVENT
Suffix:JR
Gender:M
Credentials:MA, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SOUTH POINT BLVD. N. 5TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-470-6900
Mailing Address - Fax:904-739-0171
Practice Address - Street 1:6900 SOUTH POINT BLVD. N. 5TH FLOOR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-470-6900
Practice Address - Fax:904-739-0171
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5870101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)