Provider Demographics
NPI:1811199649
Name:CARLSON, JESSICA ANN (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 WILLA SPRINGS DR
Mailing Address - Street 2:SUITE 1041
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6623
Mailing Address - Country:US
Mailing Address - Phone:407-696-4002
Mailing Address - Fax:407-696-4002
Practice Address - Street 1:1073 WILLA SPRINGS DR
Practice Address - Street 2:SUITE 1041
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6623
Practice Address - Country:US
Practice Address - Phone:407-696-4002
Practice Address - Fax:407-696-4002
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health