| Sasha Jackson, Llc | |
|
1212 N California St Stockton CA 95202-1552 | |
| (209) 242-0601 | |
| Not Available |
| Full Name | Sasha Jackson, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1212 N California St, Stockton, California |
| Authorized Official Name and Position | Sasha Ja-nae Jackson (OWNER) |
| Authorized Official Contact | 2092420601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sasha Jackson, Llc Po Box 1574 Patterson CA 95363-1574 Ph: (209) 242-0601 | Sasha Jackson, Llc 1212 N California St Stockton CA 95202-1552 Ph: (209) 242-0601 |
| NPI Number | 1083220453 |
|---|---|
| Provider Enumeration Date | 09/21/2020 |
| Last Update Date | 03/09/2021 |
| Certification Date | 03/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083220453 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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