Individual
MRS. CANDICE S JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
11026 SW 110TH AVE, DUNNELLON, FL 34432-5581
(352) 208-1458
Mailing address
11026 SW 110TH AVE, DUNNELLON, FL 34432-5581
(352) 208-1458
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MT4958
FL
Other
Enumeration date
07/29/2019
Last updated
08/09/2024
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