Individual
AMANI JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2594 INDUSTRY WAY, LYNWOOD, CA 90262-4015
(310) 667-4070
Mailing address
2594 INDUSTRY WAY, LYNWOOD, CA 90262-4015
(310) 667-4070
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
94251
CA
1041C0700X
Clinical Social Worker
Primary
94251
CA
1041C0700X
Clinical Social Worker
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7184
MEDICAL
CA
01
—
7368
MEDICAL
CA
01
—
7667
MEDICAL
CA
01
—
7708
MEDICAL
CA
Enumeration date
09/05/2018
Last updated
09/12/2025
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