| Entity Name: | KALENA SMITH-FULWILEY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 13 Feb 2017 (8 years ago) |
| Document Number: | L17000034368 |
| FEI/EIN Number | 81-5350943 |
| Address: | 13453 N. Main Street, 206, JACKSONVILLE, FL 32218 |
| Mail Address: | 13453 N. Main Street, 206, JACKSONVILLE, FL 32218 |
| ZIP code: | 32218 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538608112 | 2017-02-16 | 2017-02-16 | 15597 SPOTTED SADDLE CIR, JACKSONVILLE, FL, 322187984, US | 422 NEW BERLIN RD, JACKSONVILLE, FL, 322183827, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 904-476-9064 |
| Phone | +1 904-269-0886 |
Authorized person
| Name | KALENA SMITH-FULWILEY |
| Role | OWNER |
| Phone | 9044769064 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH12125 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | MH12125 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010404400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITHL-FULWILEY, KALENA Y, MS. | Agent | 15597 SPOTTED SADDLE CIRCLE, JACKSONVILLE, FL 32218 |
| Name | Role | Address |
|---|---|---|
| SMITH-FULWILEY, KALENA Y, MS. | Manager | 15597 SPOTTED SADDLE CIRCLE, JACKSONVILLE, FL 32218 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000051278 | THOUGHTS AND THEORIES COUNSELING SERVICES | ACTIVE | 2021-04-14 | 2026-12-31 | No data | 13453 N. MAIN STREET, #204, JACKSONVILLE, FL, 32218 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-22 | 13453 N. Main Street, 206, JACKSONVILLE, FL 32218 | No data |
| CHANGE OF MAILING ADDRESS | 2023-02-22 | 13453 N. Main Street, 206, JACKSONVILLE, FL 32218 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-02-22 |
| ANNUAL REPORT | 2022-06-11 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-02-10 |
| ANNUAL REPORT | 2019-04-14 |
| ANNUAL REPORT | 2018-02-05 |
| Florida Limited Liability | 2017-02-13 |
Date of last update: 18 Feb 2025
Sources: Florida Department of State
