Jackson, Candis L

Jackson, Candis L is an individual health care provider with primary practice located at 4161 Tamiami Trl Ste 304D , Port Charlotte FL 33952-9254. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Jackson, Candis L can be contacted via phone (941) 625-5895.

Contact Information

Primary practice address
4161 Tamiami Trl Ste 304D Port Charlotte FL 33952-9254
Phone: (941) 625-5895
Fax: (941) 625-1047
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH4441 Florida

Profile Details

NPI number 1104004746
LBN Legal business name Jackson, Candis L
Credentials LMHC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 6th, 2008
Last updated May 7th, 2024 - about 6 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104004746 NPPES
Florida MEDICAID 116480500

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