Individual
DR. SHASA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, DBH
Contact information
Practice address
950 E VAN BUREN ST, AVONDALE, AZ 85323-1506
(623) 344-6860
(602) 655-9682
Mailing address
2619 E. ROOSEVELT, PHOENIX, AZ 85008
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-20522
AZ
Other
Enumeration date
07/07/2022
Last updated
07/07/2022
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