Provider Demographics
NPI:1174387559
Name:NORTHEAST FLORIDA EMDR AND COUNSELING, LLC
Entity type:Organization
Organization Name:NORTHEAST FLORIDA EMDR AND COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-601-2252
Mailing Address - Street 1:76083 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-1682
Mailing Address - Country:US
Mailing Address - Phone:772-559-4526
Mailing Address - Fax:
Practice Address - Street 1:76083 DEERWOOD DR
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-1682
Practice Address - Country:US
Practice Address - Phone:772-559-4526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty