Organization
D.I.V.A. EMPOWERMENT GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOJAUNA JACKSON-FORBES LCSW (OWNER)
(321) 263-6994
Entity
Organization
Contact information
Practice address
274 WILSHIRE BLVD STE 237, CASSELBERRY, FL 32707-5367
(407) 545-2717
Mailing address
274 WILSHIRE BLVD STE 237, CASSELBERRY, FL 32707-5367
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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