Healthcare Provider Details

I. General information

NPI: 1982331997
Provider Name (Legal Business Name): NATIKA JACKSON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 FRANCIS ST
ALTAMONTE SPRINGS FL
32701-7502
US

IV. Provider business mailing address

975 FRANCIS ST
ALTAMONTE SPRINGS FL
32701-7502
US

V. Phone/Fax

Practice location:
  • Phone: 407-310-4427
  • Fax:
Mailing address:
  • Phone: 407-310-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: