Individual
JACKIE SPAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5749 WESTGATE DR STE 102, ORLANDO, FL 32835-5040
(321) 441-1030
Mailing address
5749 WESTGATE DR STE 102, ORLANDO, FL 32835-5040
(321) 441-8124
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
17518
FL
101YM0800X
Mental Health Counselor
17518
FL
Other
Enumeration date
02/04/2019
Last updated
06/09/2021
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