Provider Demographics
NPI:1811728355
Name:WILLIAMSON, JACKSON HOBBS
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:HOBBS
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:HOBBS
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3302 ARDEN VILLAS BLVD APT 4-18A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-2179
Mailing Address - Country:US
Mailing Address - Phone:850-865-4207
Mailing Address - Fax:
Practice Address - Street 1:601 S LAKE DESTINY RD STE 350
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7222
Practice Address - Country:US
Practice Address - Phone:855-864-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician