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General NPI Number Information
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NPI Number | 1356330765
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Entity Type | Individual
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Provider Name | SANDRA JACKSON LMHC
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Gender | Female
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 1880 SAN SEBASTIAN VW STE 4201
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-8684
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Country | US
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Telephone | 800-539-4228
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Fax |
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Provider Business Mailing Address
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Address Line | 150 MAGNOLIA AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4304
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Country | US
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Telephone | 800-539-4228
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Fax |
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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 | MH8391
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH8391
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License Number State | FL
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