Provider Demographics
NPI:1588093835
Name:VARZONI, THAIS
Entity type:Individual
Prefix:
First Name:THAIS
Middle Name:
Last Name:VARZONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 HIGHWAY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-3694
Mailing Address - Country:US
Mailing Address - Phone:904-465-1848
Mailing Address - Fax:
Practice Address - Street 1:5215 HIGHWAY AVE STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3694
Practice Address - Country:US
Practice Address - Phone:904-465-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health