Individual
ANTIONETTE MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 MELALEUCA DR, CRAWFORDVILLE, FL 32327-4963
(850) 617-9167
Mailing address
350 N CHARLES WILLIS DR, MIDWAY, FL 32343-4293
(850) 694-7555
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
03/01/2021
Last updated
03/01/2021
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