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General NPI Number Information
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NPI Number | 1659390318
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Entity Type | Individual
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Provider Name | FANITA LAKAYE JACKSON-NORMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 551 NATIONAL HEALTH CARE DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1495
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Country | US
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Telephone | 386-323-7530
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Fax |
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Provider Business Mailing Address
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Address Line | 589 S INDIGO RD
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3197
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Country | US
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Telephone | 407-463-5500
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW0004175
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License Number State | FL
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