Provider Demographics
NPI:1104926872
Name:MOOREHEAD, JAMES D (LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:MOOREHEAD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 CORDOVA AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-6021
Mailing Address - Country:US
Mailing Address - Phone:904-349-1755
Mailing Address - Fax:
Practice Address - Street 1:4028 CORDOVA AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-6021
Practice Address - Country:US
Practice Address - Phone:904-349-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 11510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health