Provider Demographics
NPI:1275346553
Name:PEACE OF MIND AMELIA, LLC
Entity type:Organization
Organization Name:PEACE OF MIND AMELIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMAGOLA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:904-206-0700
Mailing Address - Street 1:2881 TURTLE SHORES DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-6643
Mailing Address - Country:US
Mailing Address - Phone:904-206-0700
Mailing Address - Fax:585-207-6169
Practice Address - Street 1:910 S 8TH ST STE 205
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3771
Practice Address - Country:US
Practice Address - Phone:904-206-0700
Practice Address - Fax:585-207-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)