Individual
MR. ANTHONY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2237 RIVER PLAZA DR, SACRAMENTO, CA 95833-3836
(916) 391-4293
(916) 391-4247
Mailing address
2237 RIVER PLAZA DR, SACRAMENTO, CA 95833-3836
(916) 391-4293
(916) 391-4247
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5076
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5076
CAARR
CA
Enumeration date
11/29/2006
Last updated
07/08/2007
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