Provider Demographics
NPI:1417753674
Name:JACKSON, HELEN (MS)
Entity type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-4015
Mailing Address - Country:US
Mailing Address - Phone:850-544-9767
Mailing Address - Fax:850-662-1801
Practice Address - Street 1:325 JOHN KNOX RD BLDG A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4101
Practice Address - Country:US
Practice Address - Phone:850-921-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health