Individual provider · Type 1 NPI

James Derisse

Mental Health Counselor · Jacksonville, FL

NPI number 1780295170 Active

Practice location

2700 University Blvd W Bldg B
Jacksonville, FL 32217-2147

Call (904) 638-9767 Map

Mailing address

159 Silver Creek Pl
St. Augustine, FL 32095-9003

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor 101YM0800X84360 (TX)
Mental Health Counselor Primary 101YM0800X22327 (FL)

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About NPI 1780295170

James Derisse's National Provider Identifier is 1780295170, issued on Aug 11, 2020. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Jacksonville, FL. The record was last updated on Apr 25, 2024.