Provider Demographics
NPI:1154742070
Name:SINGLETARY, CEDRIC (IMH,MCAP, ICADC)
Entity type:Individual
Prefix:MR
First Name:CEDRIC
Middle Name:
Last Name:SINGLETARY
Suffix:
Gender:M
Credentials:IMH,MCAP, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 STIRLING CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-3926
Mailing Address - Country:US
Mailing Address - Phone:904-329-0024
Mailing Address - Fax:904-683-5678
Practice Address - Street 1:3636 UNIVERSITY BLVD S STE A9
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4209
Practice Address - Country:US
Practice Address - Phone:904-551-4953
Practice Address - Fax:904-683-5678
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100798171M00000X
FL5444101YA0400X
FLMCAP100381101YA0400X
FLIMH20336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1063800100Medicaid