Jackson, Shomari

Jackson, Shomari is an individual health care provider with primary practice located at 3050 Beacon Blvd Ste 103 , West Sacramento CA 95691-3467. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Jackson, Shomari can be contacted via phone (916) 462-3100.

Contact Information

Primary practice address
3050 Beacon Blvd Ste 103 West Sacramento CA 95691-3467
Phone: (916) 462-3100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1710437439
LBN Legal business name Jackson, Shomari
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 5th, 2016
Last updated Sep 29th, 2022 - about 4 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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Identifiers

StateTypeNumberIssuer
All States NPI 1710437439 NPPES
California MEDICAID 000008468

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