Individual
CHARMAYNE LATRIECE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LMHC
Contact information
Practice address
2601 NW 23RD BLVD APT 243, GAINESVILLE, FL 32605-5958
(317) 698-2713
Mailing address
2701 NW 23RD BLVD APT B20, GAINESVILLE, FL 32605-2926
(317) 698-2713
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
MH22183
FL
Other
Enumeration date
02/14/2019
Last updated
05/09/2023
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