Provider Information for 1215150420
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Ms. JENNIFER NIKOLE KENDRA MARVIN LMHC
Sex: Female
NPI: 1215150420
Last Updated: 2019-10-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1215150420 | ||||||||||||||||||||||||
| Enumeration Date | 2007-04-10 | ||||||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||||||
| Status | Active | ||||||||||||||||||||||||
| Mailing Address | 4726 FLORENCE ST APOPKA, FL 32712-5540 United States Phone: 407-929-6251 | Fax:407-788-0362 | ||||||||||||||||||||||||
| Primary Practice Address | 2400 S RIDGEWOOD AVE STE 17 SOUTH DAYTONA, FL 32119-3073 United States Phone: 407-929-6251 | Fax: | ||||||||||||||||||||||||
| Secondary Practice Address(es) | 315 N LAKEMONT AVE | ||||||||||||||||||||||||
| Health Information Exchange |
| ||||||||||||||||||||||||
| Other Identifiers |
| ||||||||||||||||||||||||
| Taxonomy |
|