person
Ms. Candis L Jackson, LMHC
Mental Health Counselor in Port Charlotte, Florida
NPI 1104004746

Candis L Jackson is a Mental Health Counselor based in Punta Gorda, FL and is specialized in Mental Health. Candis L Jackson practices in Port Charlotte, FL and has the professional credentials of LMHC. The NPI Number for Candis L Jackson is 1104004746 and holds a License No. MH4441 (Florida).

The current practice location address for Candis L Jackson is 4161 Tamiami Trl Ste 304D, Port Charlotte, FL and can be reached out via phone at 941-625-5895 and via fax at 941-625-1047.

Location: 4161 Tamiami Trl Ste 304D, Port Charlotte, FL, 33951-2139
person
Provider Profile Details
NPI Number
1104004746
Provider Name
Candis L Jackson
Credential
LMHC
Provider Entity Type
Individual
Gender
Female
Address
4161 Tamiami Trl Ste 304D, Port Charlotte, FL, 33951-2139
Phone Number
941-625-5895
Fax Number
941-625-1047
Provider Enumeration Date
02/06/2008
Last Update Date
05/18/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
116480500 05 FL
institution
Provider Business Practice Location Address Details
Address
4161 Tamiami Trl Ste 304D
City
State
Zip
33952-9254
Phone Number
941-625-5895
Fax Number
941-625-1047
person
Provider Business Mailing Address Details
Address
4161 Tamiami Trl Ste 304D
City
State
Zip
33952-9254
Phone Number
941-625-5895
Fax Number
941-625-1047
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
MH4441 (Florida)
Definition
Definition to come...
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