Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethereal Counseling Center LLC

Organization Mental Health Counselor · NPI 1164188496

Ethereal Counseling Center LLC is a Mental Health Counselor in Jacksonville, Florida. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

10035 Bengal Fox Dr
Jacksonville, FL 32222-2895
Phone: (904) 515-3326
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X
Marriage & Family Therapist Taxonomy 106H00000X

Record details

NPI number1164188496
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Dana Weiss — Credentialing Specialist · (904) 701-3076
NPI enumeratedNovember 10, 2021
Last updated in NPPESJuly 24, 2023
Certification dateJuly 24, 2023
Mailing address10035 Bengal Fox Dr, Jacksonville, FL 32222-2895

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