Individual
SHANEE DOMONIQUE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
819 E HAMMER LN APT 139, STOCKTON, CA 95210-2751
(209) 983-7290
Mailing address
819 E HAMMER LN APT 139, STOCKTON, CA 95210-2751
(209) 983-7290
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
25707
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
CA
Other
Enumeration date
05/25/2026
Last updated
05/25/2026
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