Avantzi Integrative Behavioral Health LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

AVANTZI INTEGRATIVE BEHAVIORAL HEALTH LLC

Practice address

5011 Gate Parkway
Building 100 Suite 100
Jacksonville, FL 32256

Phone

(904) 718-9672

NPI assigned

Sep 2, 2021

Last updated

Sep 8, 2021By 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

Katreva Dupont, LCSW

Title

Director

Phone

(904) 718-9672

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1417625419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5011 GATE PARKWAY",
            "address_2": "BUILDING 100 SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-718-9672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5011 GATE PARKWAY",
            "address_2": "BUILDING 100 SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-718-9672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTZI INTEGRATIVE BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-02",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A",
        "authorized_official_last_name": "DUPONT",
        "authorized_official_first_name": "KATREVA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-718-9672",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; 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.