Healthcare Provider Details

I. General information

NPI: 1003349945
Provider Name (Legal Business Name): KALIMA THEMA JACKSON WILLS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15615 HONEYBELL DR
WINTER GARDEN FL
34787-5065
US

IV. Provider business mailing address

2212 S CHICKASAW TRL STE 1069
ORLANDO FL
32825-8414
US

V. Phone/Fax

Practice location:
  • Phone: 407-986-1046
  • Fax: 689-348-7003
Mailing address:
  • Phone: 407-986-1046
  • Fax: 689-348-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: