Healthcare Provider Details

I. General information

NPI: 1578851887
Provider Name (Legal Business Name): CAROL BURRELL-JACKSON PH.D., MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 SE 18TH ST STE 901
OCALA FL
34471-5445
US

IV. Provider business mailing address

1202 SW 17TH ST STE 201-158
OCALA FL
34471-1271
US

V. Phone/Fax

Practice location:
  • Phone: 352-887-0770
  • Fax: 352-368-6978
Mailing address:
  • Phone: 352-887-0770
  • Fax: 352-368-6978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16268
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801035881
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: