| Organization Name: | SOUTHSIDE COUNSELING BIOFEEDBACK AND STRESS MANAGEMENT CENTER |
| NPI Number: | 1679637961 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SOLOMON STANFORD (OFFICE MANAGER) |
| Mailing Address: | 5730 Bowden Rd 105 Jacksonville |
| State: | FL US |
| Postal Code: | 322166104 |
| Phone Number: | 9047376700 |
| Fax Number: | 9047376774 |
| NPI Enumeration Date: | 12/20/2006 |
| NPI Last Update Date: | 04/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | MH0003114 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |