Female

Mrs. Tierra Jackson LPCA, LMFTA, RMFTI

Marriage & Family Therapist in Palm Bay, FL(View on Map)

Full Name

Mrs. Tierra Jackson LPCA, LMFTA, RMFTI

NPI Number

1225440548

NPI Type

Individual Provider

Gender

Female

Enumeration Date

05/21/2014

Specialties

(Taxonomies)

Code

106H00000X
101YP2500X

Primary Taxonomy

Yes
No

Licenses

State

Florida
North Carolina
North Carolina

License Number

IMT2200
9096A
A10704

Contact
Information

Purpose

Mailing
Location

Address

910 UTE TRL
4680 LIPSCOMB ST NE

City

Patrick Afb
Palm Bay

State

FL
FL

Postal Code

32925-3160
32905-2984

Country

US
US

Telephone Number

(828) 994-7718
(321) 433-3570

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 12/17/2014

Provider Address

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