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General NPI Number Information
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NPI Number | 1679451454
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Entity Type | Organization
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Legal Business Name | TRANSFORMATION COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 10/12/2025
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Provider Practice Location Address
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Address Line | 10752 DEERWOOD PARK BLVD STE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4846
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Country | US
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Telephone | 904-503-5262
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Fax | 904-895-5748
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Provider Business Mailing Address
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Address Line | 10752 DEERWOOD PARK BLVD STE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4846
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Country | US
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Telephone | 904-503-5264
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Fax | 904-895-5748
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Authorized Official
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Title or Position | CEO
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Name | MS. DERDA JACKSON
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Credential | LMHC
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Telephone | 904-503-5264
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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 |
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License Number State |
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