Provider Demographics
NPI:1124857453
Name:GARDNER, RASHAD R (MS IN CMHC)
Entity type:Individual
Prefix:
First Name:RASHAD
Middle Name:R
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MS IN CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3208
Mailing Address - Country:US
Mailing Address - Phone:402-201-9149
Mailing Address - Fax:
Practice Address - Street 1:4812 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3208
Practice Address - Country:US
Practice Address - Phone:402-201-9149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health