Healthcare Provider Details

I. General information

NPI: 1922797703
Provider Name (Legal Business Name): JACQUELINE A MEREDITH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W. CANTON AVENUE SUITE 600
WINTER PARK FL
32789-3181
US

IV. Provider business mailing address

225 W CANTON AVENUE SUITE 600
WINTER PARK FL
32789-3181
US

V. Phone/Fax

Practice location:
  • Phone: 407-347-4536
  • Fax: 812-285-8392
Mailing address:
  • Phone: 407-347-4536
  • Fax: 812-285-8392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH15366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: