Full Connections Counseling

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

FULL CONNECTIONS COUNSELING

Practice address

752 Blanding Blvd Ste 130
Orange Park, FL 32065-5790

Phone

(904) 637-5297

NPI assigned

May 2, 2019

Organization subpart

No

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

Authorized official

Name

Domonique Jackson, LCSW

Title

Owner

Phone

(904) 637-5297

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1556755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593043200000",
    "number": "1790340065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3045 RUSSELL RD",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "320438209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "752 BLANDING BLVD STE 130",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320655790",
            "telephone_number": "904-637-5297"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3100 University Blvd S Ste 218",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322162727",
            "country_code": "US",
            "telephone_number": "904-505-1844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FULL CONNECTIONS COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-02",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DOMONIQUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-637-5297",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebekah Lynne Fronczak
• Kelly K Frustaci, PT
• Janae Fry, DO
• Juan Francisco Fuentes, DO
• Full Circle Counseling Services, LLC
• Courtney Fuller
• Functional Kids Therapy LLC
• Gaines C Martin MD PHD PA
• Andrea Gainey, PTA
• Gaither Counseling & Wellness, LLC

• Community/Behavioral Health Agency in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; 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.