Individual
CHERISE LEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC-I
Contact information
Practice address
335 6TH ST, HOLLISTER, CA 95023-3834
(831) 265-7317
Mailing address
335 6TH ST, HOLLISTER, CA 95023-3834
(831) 665-2954
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CI35650522
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R1376770120
CCAPP
CA
Enumeration date
06/02/2021
Last updated
01/18/2023
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