Individual
MRS. BRANDI JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1700 WELLS RD STE 11, ORANGE PARK, FL 32073-2373
(904) 670-0810
(904) 670-0818
Mailing address
194 BRENTLEY LN, ORANGE PARK, FL 32065-5614
(904) 207-3207
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
SW19231
FL
1041C0700X
Clinical Social Worker
Primary
SW19231
FL
Other
Enumeration date
02/14/2022
Last updated
12/01/2023
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