Provider Demographics
NPI:1851970222
Name:JACKSON, SABRINA DENISE (EDS, LMHC, MS)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:DENISE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:EDS, LMHC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9716 SW 213TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3702
Mailing Address - Country:US
Mailing Address - Phone:786-301-9308
Mailing Address - Fax:
Practice Address - Street 1:9716 SW 213TH TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3702
Practice Address - Country:US
Practice Address - Phone:786-301-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health