Provider Demographics
NPI:1447840491
Name:VENDITTI COUNSELING LLC
Entity type:Organization
Organization Name:VENDITTI COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENDITTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-238-8527
Mailing Address - Street 1:6620 SOUTHPOINT DR S STE 450I
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0912
Mailing Address - Country:US
Mailing Address - Phone:904-238-8527
Mailing Address - Fax:
Practice Address - Street 1:6620 SOUTHPOINT DR S STE 450I
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0912
Practice Address - Country:US
Practice Address - Phone:904-469-7195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-24
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)