Individual
MS. CANDIS L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
4161 TAMIAMI TRL STE 304D, PORT CHARLOTTE, FL 33952-9254
(941) 625-5895
(941) 625-1047
Mailing address
PO BOX 512139, PUNTA GORDA, FL 33951-2139
(941) 625-5895
(941) 625-1047
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH4441
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116480500
—
FL
Enumeration date
02/06/2008
Last updated
05/07/2024
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