Provider Demographics
NPI:1194470567
Name:NASSAU COUNTY MENTAL HEALTH ALCOHOL & DRUG ABUSE
Entity type:Organization
Organization Name:NASSAU COUNTY MENTAL HEALTH ALCOHOL & DRUG ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES GENERALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-225-8280
Mailing Address - Street 1:463142 STATE ROAD 200
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-5554
Mailing Address - Country:US
Mailing Address - Phone:904-225-8280
Mailing Address - Fax:904-225-8232
Practice Address - Street 1:2201 SADLER RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4558
Practice Address - Country:US
Practice Address - Phone:904-225-8280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASSAU COUNTY MENTAL HEALTH ALCOHOL & DRUG ABUSE COUNCIL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029593100Medicaid