Provider Demographics
NPI:1750946158
Name:FIRST COAST INTEGRATIVE PSYCHIATRY
Entity type:Organization
Organization Name:FIRST COAST INTEGRATIVE PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-339-3064
Mailing Address - Street 1:2220 COUNTY ROAD 210 W STE 108-221
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4058
Mailing Address - Country:US
Mailing Address - Phone:352-339-6311
Mailing Address - Fax:
Practice Address - Street 1:304 KINGSLEY LAKE DR STE 601
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3042
Practice Address - Country:US
Practice Address - Phone:352-339-3064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty