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