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

David Edwin Roddenberry

Individual provider Mental Health Counselor · NPI 1962217489

David Edwin Roddenberry is a Mental Health Counselor in Saint Augustine, Florida. Practices as a sole proprietor. Licensed in Florida.

Licensed in
FL
In the registry since
2025

Practice location Address checks out

109 Nature Walk Pkwy Unit 104
Saint Augustine, FL 32092-5065
Phone: (407) 748-0982
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence MH25268 (FL)

Record details

NPI number1962217489
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 11, 2025
Last updated in NPPESMarch 4, 2025
Certification dateMarch 4, 2025
Mailing address24 Seahill Dr, Saint Augustine, FL 32092-1112

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