Active NPI
Wendi-Jo Bianca Cancilla, LMHC
- Mental Health Counselor
- Jacksonville, FL
National Provider Identifier
1194958934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH8430
- Practice address
- 4080 Woodcock Dr
Midtown Centre, Building 2400, Suite 105
Jacksonville, FL 32207-2722 - Phone
- (904) 396-1770
- Fax
- (904) 396-1897
- NPI assigned
- Aug 27, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH8430 | FL | Primary |
Addresses
Primary practice location
4080 Woodcock Dr
Midtown Centre, Building 2400, Suite 105
Jacksonville, FL 32207-2722
Mailing address
PO Box 19249
Jacksonville, FL 32245-9249
Phone (904) 743-1883
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 767278100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH8430 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251331200000",
"number": "1194958934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19249",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322459249",
"telephone_number": "904-743-1883",
"fax_number": "904-743-5109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4080 WOODCOCK DR",
"address_2": "MIDTOWN CENTRE, BUILDING 2400, SUITE 105",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322072722",
"telephone_number": "904-396-1770",
"fax_number": "904-396-1897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANCILLA",
"first_name": "WENDI-JO",
"middle_name": "BIANCA",
"name_prefix": "Ms.",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-27",
"last_updated": "2009-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH8430",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "767278100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
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- Cancer Specialists, LLC (Florida Specialty Pharmacy)
- John Wunn Cancian Sr., MD
- Michael C Cancio, M.D.
- Candace Cares LLC
- Dan Candea, MD
- Astrid Candelaria-Jimenez, PHARMD
- David J Cangemi, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.