Provider Demographics
NPI:1841931508
Name:MINCEY, CAMILLIA
Entity type:Individual
Prefix:
First Name:CAMILLIA
Middle Name:
Last Name:MINCEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 SPRING PARK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5988
Mailing Address - Country:US
Mailing Address - Phone:904-737-5000
Mailing Address - Fax:904-737-5008
Practice Address - Street 1:5600 SPRING PARK RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5988
Practice Address - Country:US
Practice Address - Phone:904-737-5000
Practice Address - Fax:904-737-5008
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)