SRC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SRC

Practice address

580 Ellis Rd S
Jacksonville, FL 32254-3582

Phone

(678) 886-3984

NPI assigned

Apr 9, 2015

Organization subpart

No

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

Authorized official

Name

Tanya Lake-Smith

Title

Mental Health Counselor

Phone

(678) 886-3984

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1428537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428537600000",
    "number": "1841686433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11993 ALEXANDRA DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322188880",
            "telephone_number": "678-886-3984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 ELLIS RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322543582",
            "telephone_number": "678-886-3984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-09",
        "last_updated": "2015-04-09",
        "status": "A",
        "authorized_official_last_name": "LAKE-SMITH",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "MENTAL HEALTH COUNSELOR",
        "authorized_official_telephone_number": "678-886-3984"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Lee Spurling, OD
• Cecilia Spurlock
• Sawyer Spurry, NP
• Samuel Squier, MD
• Jacqueline Squire, MD
• Sriganesh Wellness
• Sarala Hosdurga Srinivasa, M.D.
• Sridhar Srinivasan, MD
• Archit Ajay Srivastava, M.B.B.S/MD
• SS Duval Community HC LLC

• Community/Behavioral Health Agency in Jacksonville, FL
• Providers in Jacksonville, 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 Apr 9, 2015; 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.