Individual
CANDYCE S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
909 PICO BLVD, SANTA MONICA, CA 90405-1326
(310) 314-6200
Mailing address
909 PICO BLVD, SANTA MONICA, CA 90405-1326
(310) 314-6200
(909) 421-7128
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AII051011123
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
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Other
Enumeration date
06/08/2020
Last updated
02/01/2024
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