Individual
KHANDIS JACKSON CLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CBHCM
Contact information
Practice address
755 27TH AVE SW STE 9, VERO BEACH, FL 32968-4210
(850) 519-6232
Mailing address
2050 13TH AVE STE 1761, VERO BEACH, FL 32960-4429
(850) 519-6232
(772) 257-6078
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
CBHCM103665
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SSN
—
FL
Enumeration date
10/10/2019
Last updated
09/27/2021
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