Organization
FULL CONNECTIONS COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMONIQUE JACKSON LCSW (OWNER)
(904) 637-5297
Entity
Organization
Contact information
Practice address
752 BLANDING BLVD STE 130, ORANGE PARK, FL 32065-5790
(904) 637-5297
Mailing address
3045 RUSSELL RD, GREEN COVE SPRINGS, FL 32043-8209
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/02/2019
Last updated
06/25/2020
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