DAVID EDWIN RODDENBERRY
NPI 1962217489
Counselor - Mental Health in Saint Augustine, FL

Q: What is David Roddenberry's NPI number?

The NPI number for David Roddenberry is 1962217489. It was assigned to this individual provider in the NPPES registry on February 11, 2025.

Q: What is David Roddenberry's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for David Roddenberry was last updated on March 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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.

Active since February 11, 2025

109 NATURE WALK PKWY UNIT 104, SAINT AUGUSTINE, FL 32092(407) 748-0982 Get Directions Write a Review

NPPES record last updated: March 4, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 4, 2025, Feb 11, 2025 (2 updates tracked since 2025).

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About David Edwin Roddenberry NPPES

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

DAVID EDWIN RODDENBERRY (NPI 1962217489) is an individual mental health provider in Saint Augustine, Florida, licensed in Florida (MH25268) and active in the NPI registry since February 2025.

NPPES Registry Identity

NPI1962217489

Entity TypeIndividualMale

Primary Taxonomy101YM0800X

Provider Legal NameDAVID EDWIN RODDENBERRY

Location Address109 NATURE WALK PKWY UNIT 104Saint Augustine, FL 32092-5065

Mailing Address24 Seahill DrSaint Augustine, FL 32092-1112 · (407) 748-0982

Phone(407) 748-0982

Sole ProprietorYes

Enumeration DateFebruary 11, 2025

Last NPPES UpdateMarch 4, 20252 updates tracked since enumeration

NPPES CertifiedMarch 4, 2025

✔ NPI 1962217489 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in FL · MH25268

109 NATURE WALK PKWY UNIT 104, Saint Augustine, FL 32092

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Other Providers at the Same Location NPPES 3

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

AUTHENTICALLY YOU, LLC

Community/Behavioral Health

109 NATURE WALK PKWY UNIT 104
SAINT AUGUSTINE, FL 32092

St. Johns County (904) 629-1565

LINDA RITCH

Counselor (Mental Health)

109 NATURE WALK PKWY UNIT 104
ST AUGUSTINE, FL 32092

St. Johns County (904) 710-7586

REFORGED IN FAITH LLC

Counselor (Mental Health)

109 NATURE WALK PKWY UNIT 104
ST AUGUSTINE, FL 32092

St. Johns County (407) 748-0982

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 David Roddenberry's NPI number?

The NPI number for David Roddenberry is 1962217489. It was assigned to this individual provider in the NPPES registry on February 11, 2025.

Where is David Roddenberry located?

David Roddenberry practices at 109 Nature Walk Pkwy Unit 104, Saint Augustine, FL 32092. The listed phone number is (407) 748-0982.

What is David Roddenberry's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for David Roddenberry was last updated on March 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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.