Individual
CHARLENE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1135 S ALVARADO ST, LOS ANGELES, CA 90006-4100
(323) 540-9016
Mailing address
1135 S ALVARADO ST, LOS ANGELES, CA 90006-4100
(323) 540-9016
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/13/2014
Last updated
05/03/2023
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