Female

Mrs. Sandra Jackson LMHC

Mental Health Counselor in St Augustine, FL(View on Map)

Full Name

Mrs. Sandra Jackson LMHC

NPI Number

1356330765

NPI Type

Individual Provider

Gender

Female

Enumeration Date

10/18/2005

Specialties

(Taxonomies)

Code

101YM0800X
101Y00000X

Primary Taxonomy

Yes
No

Licenses

State

Florida

License Number

MH8391

Contact
Information

Purpose

Mailing
Location

Address

1955 US HIGHWAY 1 S
1955 US HIGHWAY 1 S

City

St Augustine
St Augustine

State

FL
FL

Postal Code

32086-3708
32086-3708

Country

US
US

Telephone Number

(904) 209-6222
(904) 209-6222

Identifiers

Identifier

767122900
Z089A

Identifier State

FL
FL

Identifier Issuer

Unknown
BCBS

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

Data last updated by provider on 07/24/2012

Provider Address

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