Provider Demographics
NPI:1649046574
Name:MENTAL HEALTH HYGIENE AND WELLNESS CLINIC, 'LLC'
Entity type:Organization
Organization Name:MENTAL HEALTH HYGIENE AND WELLNESS CLINIC, 'LLC'
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:APPIADU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-FMNP-BC
Authorized Official - Phone:904-563-0237
Mailing Address - Street 1:516 ABBOTSFORD CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8777 SAN JOSE BLVD STE 802
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4291
Practice Address - Country:US
Practice Address - Phone:904-921-9267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty