Jackson, Georgia

Jackson, Georgia is an individual health care provider with primary practice located at 1001 Potrero Ave Ward 93, San Francisco CA 94110-3518. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Jackson, Georgia can be contacted via phone (415) 206-6142.

Contact Information

Primary practice address
1001 Potrero Ave Ward 93 San Francisco CA 94110-3518
Phone: (415) 206-6142
Fax: (415) 206-6875
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 051192IV California

Profile Details

NPI number 1285837088
LBN Legal business name Jackson, Georgia
Credentials CATC
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2007
Last updated Feb 28th, 2019 - about 5 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 1285837088 NPPES
Other 31836 SFGH INTERNAL USE ONLY
Other 31836 SFGH INTERNAL USE ONLY

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