Jackson, Sandra

Jackson, Sandra is an individual health care provider with primary practice located at 1955 Us Highway 1 S Suite C-2, St Augustine FL 32086-3708. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Counselor. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Jackson, Sandra can be contacted via phone (904) 209-6222.

Contact Information

Primary practice address
1955 Us Highway 1 S Suite C-2 St Augustine FL 32086-3708
Phone: (904) 209-6222
Fax: (904) 209-6291
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH8391 Florida
Behavioral Health & Social Service Providers / Counselor 101Y00000X MH8391 Florida

Profile Details

NPI number 1356330765
LBN Legal business name Jackson, Sandra
Credentials LMHC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 18th, 2005
Last updated Jul 24th, 2012 - about 12 years 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 1356330765 NPPES
Florida MEDICAID 767122900
Florida Other Z089A

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