Provider Demographics
NPI:1437373594
Name:HARRIS-JACKSON, TAMECA N (PHD, LCSW, CSE)
Entity Type:Individual
Prefix:DR
First Name:TAMECA
Middle Name:N
Last Name:HARRIS-JACKSON
Suffix:
Gender:F
Credentials:PHD, LCSW, CSE
Other - Prefix:DR
Other - First Name:TAMECA
Other - Middle Name:NICOLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LCSW, CSE
Mailing Address - Street 1:1400 S ORLANDO AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5543
Mailing Address - Country:US
Mailing Address - Phone:407-308-0345
Mailing Address - Fax:689-204-1475
Practice Address - Street 1:1400 S ORLANDO AVE STE 320
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5543
Practice Address - Country:US
Practice Address - Phone:407-308-0345
Practice Address - Fax:689-204-1475
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500783191041C0700X
FLSW150801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical