Individual
ANDRE NAKROMBA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MFTI
Contact information
Practice address
17800 US HIGHWAY 18, APPLE VALLEY, CA 92307-1221
(760) 552-6700
Mailing address
17800 US HIGHWAY 18, APPLE VALLEY, CA 92307-1221
(760) 552-6700
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
123981
CA
106H00000X
Marriage & Family Therapist
Primary
129229
CA
106H00000X
Marriage & Family Therapist
84202
CA
Other
Enumeration date
12/01/2015
Last updated
11/16/2021
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