Provider Demographics
NPI:1578901740
Name:SOCKOL, JAMIE KATHLEEN (LMHC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:KATHLEEN
Last Name:SOCKOL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:KATHLEEN
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:13762 W STATE ROAD 84 UNIT 159
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-5305
Mailing Address - Country:US
Mailing Address - Phone:954-667-9844
Mailing Address - Fax:
Practice Address - Street 1:13800 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-6516
Practice Address - Country:US
Practice Address - Phone:954-531-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health