Individual
ANDRE PRICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3450 3RD ST, SAN FRANCISCO, CA 94124-1443
(415) 437-3990
(415) 437-3994
Mailing address
PO BOX 591, FORESTVILLE, CA 95436-0591
(310) 913-5265
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
117677
CA
106H00000X
Marriage & Family Therapist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/02/2018
Last updated
08/21/2020
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