Doctor Name: | JILLIAN JACKSON |
NPI Number: | 1457672594 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | SW 11320 |
Business Practice Address: | 559 Zachary Dr Apopka, FL - 327122384 |
Business Phone Number: | 4079230641 |
Business Fax Number: | |
Mailing Address: | 559 Zachary Dr, APOPKA |
State: | FL |
Postal Code: | 327122384 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/11/2010 |
NPI Last Update Date: | 12/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | SW 11320 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |