Provider Information for 1194182410
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MELISSA WHITLOW LMHC
Organization Subpart: NO
NPI: 1194182410
Last Updated: 2016-01-16
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1194182410 | ||||||||
| Enumeration Date | 2016-01-16 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: MELISSA J WHITLOW Title: Licensed Mental Health Counselor Phone: 9043076373 | ||||||||
| Mailing Address | 1743 COUNTY ROAD 220 FLEMING ISLAND, FL 32003-7917 United States Phone: 904-307-6373 | Fax: | ||||||||
| Primary Practice Address | 329 W ADELAIDE DR SAINT JOHNS, FL 32259-6931 United States Phone: 904-307-6373 | Fax: | ||||||||
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