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General NPI Number Information
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NPI Number | 1205487006
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Entity Type | Individual
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Provider Name | DANIELLA JACKSON PH.D, LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 7813 MITCHELL BLVD STE 106
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-4723
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Country | US
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Telephone | 727-767-9850
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Fax | 727-767-9851
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Provider Business Mailing Address
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Address Line | 7813 MITCHELL BLVD STE 106
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-4723
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Country | US
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Telephone | 727-767-9850
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Fax | 727-767-9851
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH11216
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License Number State | FL
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