Healthcare Provider Details

I. General information

NPI: 1770916264
Provider Name (Legal Business Name): OCALA CONSULTING & PREVENTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 SE 17TH ST STE 102
OCALA FL
34471-9109
US

IV. Provider business mailing address

2303 SE 17TH ST STE 102
OCALA FL
34471-9109
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-4488
  • Fax: 352-565-2196
Mailing address:
  • Phone: 352-622-4488
  • Fax: 352-565-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10396
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JACKIE GIBSON-JACOBOWITZ
Title or Position: CEO
Credential: LMHC, MCAP
Phone: 352-622-4488