| Entity Name: | J-NISSI'S THERAPY & COUNSELING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Apr 2017 (8 years ago) |
| Document Number: | L17000087291 |
| FEI/EIN Number | 821255473 |
| Address: | 630 KINGSLEY AVENUE, ORANGE PARK, FL, 32073, US |
| Mail Address: | 630 Kingsley Avenue, Orange Park, FL, 32073, US |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558890392 | 2017-06-06 | 2022-07-21 | 1536 KINGSLEY AVE STE 120, ORANGE PARK, FL, 320734525, US | 1536 KINGSLEY AVE STE 120, ORANGE PARK, FL, 320734525, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 904-304-3800 |
| Fax | 9046447123 |
Authorized person
| Name | MS. RENEE ANITA DUNHAM |
| Role | OWNER |
| Phone | 9033043800 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH11462 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA DEPARTMENT HEALTH |
| Number | MH11462 |
| State | FL |
| Issuer | MEDICAID |
| Number | 007347100 |
| State | FL |
| Issuer | FLORIDA CERTIFICATION BOARD |
| Number | 5901 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DUNHAM RENEE A | Agent | 630 KINGLSEY AVE, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| DUNHAM RENEE A | Manager | 630 KINGLSEY AVE, ORANGE PARK, FL, 32073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2025-01-11 | 630 KINGSLEY AVENUE, ORANGE PARK, FL 32073 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-03 | 630 KINGSLEY AVENUE, ORANGE PARK, FL 32073 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-01-13 | 630 KINGLSEY AVE, ORANGE PARK, FL 32073 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-11 |
| ANNUAL REPORT | 2024-01-18 |
| ANNUAL REPORT | 2023-01-06 |
| ANNUAL REPORT | 2022-02-03 |
| ANNUAL REPORT | 2021-01-21 |
| ANNUAL REPORT | 2020-01-26 |
| ANNUAL REPORT | 2019-01-30 |
| ANNUAL REPORT | 2018-01-13 |
| Florida Limited Liability | 2017-04-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
