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SRC
NPI 1841686433
Community/Behavioral Health in Jacksonville, FL

Active since April 09, 2015
580 ELLIS RD S, JACKSONVILLE, FL 32254(678) 886-3984 Get Directions Write a Review

NPPES record last updated: April 9, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Src NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SRC (NPI 1841686433) is a healthcare organization registered as a community/behavioral health in Jacksonville, Florida and active in the NPI registry since April 2015. The organization lists Tanya Lake-smith, Mental Health Counselor, as its authorized official.

NPPES Registry Identity

NPI1841686433
Entity TypeOrganization
Primary Taxonomy251S00000X
Legal Business NameSRC
Location Address580 ELLIS RD SJacksonville, FL 32254-3582
Mailing Address11993 Alexandra DrJacksonville, FL 32218-8880 · (678) 886-3984
Phone(678) 886-3984
Organization SubpartNo
Authorized OfficialTanya Lake-smithMental Health Counselor · (678) 886-3984
Enumeration DateApril 9, 2015
✔ NPI 1841686433 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity/Behavioral HealthAgencies
Taxonomy Code251S00000X
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
580 ELLIS RD S, Jacksonville, FL 32254
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Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SOUTH REHABILITATION CENTER, INC.
Community/Behavioral Health
580 ELLIS RD S, SUITE 118
JACKSONVILLE, FL 32254
Duval County (904) 423-0017
STEPHANIE CHERYL BOSH MS, MCAP
Counselor
580 ELLIS RD S
JACKSONVILLE, FL 32254
Duval County (904) 423-0017
MELISSA MORROW LAMB
Counselor
580 ELLIS RD S, STE 118
JACKSONVILLE, FL 32254
Duval County (904) 423-0017
MS. JACQUELINE BAKER MH21380
Counselor (Addiction (Substance Use Disorder))
580 ELLIS RD S
JACKSONVILLE, FL 32254
Duval County (904) 423-0017
ROSE MARIE PENA
Marriage & Family Therapist
580 ELLIS RD S, SUITE 118
JACKSONVILLE, FL 32254
Duval County (904) 423-0017
ALEXANDRA JONES MA
Counselor (Mental Health)
580 ELLIS RD S, STE 118
JACKSONVILLE, FL 32254
Duval County (904) 423-0017

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Src's NPI number?

The NPI number for Src is 1841686433. It was assigned to this organization in the NPPES registry on April 9, 2015.

Where is Src located?

Src is located at 580 Ellis Rd S, Jacksonville, FL 32254. The listed phone number is (678) 886-3984.

What is Src's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

When was this NPI record last updated?

The NPPES record for Src was last updated on April 9, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.