NPIMap

Organization Active NPI

Southside Counselling Center LLC

  • Professional Counselor
  • Jacksonville, FL
National Provider Identifier
1124304167
Registry record updated Mar 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
MH8370 Issued in FL
Legal business name
SOUTHSIDE COUNSELLING CENTER LLC
Practice address
3681 Carol Ann LN
Jacksonville, FL 32223-7394
Phone
(904) 316-3365
Fax
(904) 292-2409
NPI assigned
Oct 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Carmella Gardner, LMHCNPI 1255423638
Title
Owner
Phone
(904) 316-3365

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X MH8370 FL Primary

Addresses

Primary practice location

3681 Carol Ann LN
Jacksonville, FL 32223-7394

Mailing address

2950 Halcyon LN
Jacksonville, FL 32223-6689
Phone (904) 316-3365

National Provider Directory

National Provider Directory
Tax ID family
Carmella Gardner2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331683200000",
    "number": "1124304167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 HALCYON LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322236689",
            "telephone_number": "904-316-3365",
            "fax_number": "904-292-2409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3681 CAROL ANN LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322237394",
            "telephone_number": "904-316-3365",
            "fax_number": "904-292-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE COUNSELLING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-21",
        "last_updated": "2012-03-14",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "CARMELLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-316-3365",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "FL",
            "license": "MH8370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.