Provider Demographics
NPI:1710180765
Name:JACKSON-FORBES, TOJAUNA LA'TRICE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TOJAUNA
Middle Name:LA'TRICE
Last Name:JACKSON-FORBES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TOJAUNA
Other - Middle Name:LA'TRICE
Other - Last Name:FORBES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:97 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7515
Mailing Address - Country:US
Mailing Address - Phone:321-263-6994
Mailing Address - Fax:
Practice Address - Street 1:1025 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5523
Practice Address - Country:US
Practice Address - Phone:321-263-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW82781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical