Provider Information for 1013605377
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SALISA JACKSON GARRAND LMHC
Sex: Female
NPI: 1013605377
Last Updated: 2025-02-12
Certification Date: 2025-02-12
Certification Date: 2025-02-12
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1013605377 | ||||||||||||
| Enumeration Date | 2023-04-25 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 12510 NW LYNCH LN PORT ST LUCIE, FL 34987-3055 United States Phone: 908-547-9219 | Fax: | ||||||||||||
| Primary Practice Address | 12510 NW LYNCH LN PORT ST LUCIE, FL 34987-3055 United States Phone: 908-547-9219 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 586 PRESIDENT ST APT 6D | ||||||||||||
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