Innovation Counseling Center

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH13087 Issued in FL

Legal business name

INNOVATION COUNSELING CENTER

Practice address

9951 Atlantic Blvd
442
Jacksonville, FL 32225-6584

Phone

(904) 274-6255

NPI assigned

Apr 15, 2015

Last updated

Nov 29, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Angela Malone, LMHC

Title

Ceo

Phone

(904) 719-1043

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angela Smalls, LMHC

  • Mental Health Counselor
  • Tampa, FL
  • NPI 1801287644
  NPD (past)

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

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1164818217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9951 ATLANTIC BLVD",
            "address_2": "442",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322256584",
            "telephone_number": "904-327-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9951 ATLANTIC BLVD",
            "address_2": "442",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322256584",
            "telephone_number": "904-274-6255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATION COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-15",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "MALONE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-719-1043",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH13087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; 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.