Jacqueline Leigh (Preferred) Mathis, Registered Intern
Counselor, Mental Health in St Augustine, FL. Individual provider (NPI-1).
NPI number1194512293
StatusActive
Last updated in NPPESJul 1, 2026
Details
- NPI
- 1194512293
- Entity type
- Individual (NPI-1)
- Name
- Jacqueline Leigh (Preferred) Mathis
- Credential
- Registered Intern
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 22, 2025
- Certification date
- Jul 1, 2026
- Last updated
- Jul 1, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | MH27996 | FL | Yes |
Practice location
319 W Town Pl Ste 21St Augustine, FL 32092-3103
Phone 904-640-9099
Mailing address
2872 N 1st StSt Augustine, FL 32084-1942
Phone 561-676-2529
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