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Organization
TIDEWATER MENTAL HEALTH COUNSELING PLLC
Active
Organization
TIDEWATER MENTAL HEALTH COUNSELING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN JACKSON LMHC-D (OWNER)
(484) 599-1580
Entity
Organization
Contact information
Practice address
172 W 21ST ST, HUNTINGTON STATION, NY 11746-2122
(484) 599-1580
Mailing address
172 W 21ST ST, HUNTINGTON STATION, NY 11746-2122
(484) 599-1580
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
03/20/2025
Last updated
03/20/2025
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