Jackson, Phoenix

Jackson, Phoenix is an sole proprietor health care provider with primary practice located at 1 Saint Vincents Dr , San Rafael CA 94903-1504. She recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Marriage & Family Therapist, Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / School, Student, Health Care / Student in an Organized Health Care Education/Training Program, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Jackson, Phoenix can be contacted via phone (415) 610-1768.

Contact Information

Primary practice address
1 Saint Vincents Dr San Rafael CA 94903-1504
Phone: (415) 610-1768
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 91873 California
Behavioral Health & Social Service Providers / Counselor 101Y00000X
Behavioral Health & Social Service Providers / School 101YS0200X
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X 91873 California
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 91873 California

Profile Details

NPI number 1619349933
LBN Legal business name Jackson, Phoenix
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 26th, 2015
Last updated Oct 25th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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