Provider Demographics
NPI:1922803436
Name:GARDINER, ANTHONY JAMES (LPC-S)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES
Last Name:GARDINER
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 PHILIPS HWY STE 31
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-6840
Mailing Address - Country:US
Mailing Address - Phone:904-399-8351
Mailing Address - Fax:904-399-8355
Practice Address - Street 1:3728 PHILIPS HWY STE 31
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-6840
Practice Address - Country:US
Practice Address - Phone:904-399-8351
Practice Address - Fax:904-399-8355
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3979101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health