Active NPI
Carmella Gardner
Doing business as Southside Counseling Center
- Community/Behavioral Health Agency
- Jacksonville, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- MH8370
- Legal business name
- CARMELLA GARDNER
- Doing business as
- Southside Counseling Center
- Practice address
- 2950 Halcyon LN
Suite 701
Jacksonville, FL 32223-6689 - Phone
- (904) 292-2407
- Fax
- (904) 292-2409
- NPI assigned
- Dec 28, 2015
- Last updated
- Feb 11, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Carmella C Gardner, LMHC
- Title
- Owner
- Phone
- (904) 292-2497
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | MH8370 | FL | Primary |
Addresses
Primary practice location
2950 Halcyon LN
Suite 701
Jacksonville, FL 32223-6689
Mailing address
3681 Carol Ann LN
Jacksonville, FL 32223-7394
Phone (904) 292-2407
Other names 1
- Southside Counseling Center
National Provider Directory
National Provider Directory- Tax ID family
- Carmella Gardner
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Professional Counselor
- Jacksonville, FL
- NPI 1124304167
Practitioners & affiliated clinicians
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.
-
- Mental Health Counselor
- Jacksonville, FL
- NPI 1255423638
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451260800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1455148800000",
"number": "1275998767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3681 CAROL ANN LN",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322237394",
"telephone_number": "904-292-2407",
"fax_number": "904-292-2409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2950 HALCYON LN",
"address_2": "SUITE 701",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322236689",
"telephone_number": "904-292-2407",
"fax_number": "904-292-2409"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CARMELLA GARDNER",
"organizational_subpart": "NO",
"enumeration_date": "2015-12-28",
"last_updated": "2016-02-11",
"status": "A",
"authorized_official_last_name": "GARDNER",
"authorized_official_first_name": "CARMELLA",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "904-292-2497",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "LMHC"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "FL",
"license": "MH8370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Southside Counseling Center",
"code": "3",
"type": "Doing Business As"
}
]
}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 Feb 11, 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.