Avanti Wellness Center Inc

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

AVANTI WELLNESS CENTER INC

Practice address

165 Southpark Blvd
Suite D
St Augustine, FL 32086-4101

Phone

(904) 824-7597

Fax

(904) 824-7598

NPI assigned

Aug 11, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Denise R Odom

Title

Office Manager

Phone

(904) 824-7597

Specialties & licenses 3

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Randi Bloom-Brazer, LCSW

  • Clinical Social Worker
  • St Augustine, FL
  • NPI 1740466929
  NPD (past)

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1861403974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 SOUTHPARK BLVD",
            "address_2": "SUITE D",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864101",
            "telephone_number": "904-824-7597",
            "fax_number": "904-824-7598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 SOUTHPARK BLVD",
            "address_2": "SUITE D",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864101",
            "telephone_number": "904-824-7597",
            "fax_number": "904-824-7598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTI WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "904-824-7597",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY7098",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW5151",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "HCC7024",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.