NPI: 1083220453
Provider Name: SASHA JACKSON, LLC
Former Legal Business Name: SASHA JACKSON, LLC
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization
Specialization: Mental Health (Including Community Mental Health Center)
Address:
1212 N CALIFORNIA ST
STOCKTON, CA
ZIP 95202
Phone: (209) 242-0601
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SASHA JACKSON, LLC is a mental health (including community mental health center) clinic center in Stockton, CA. SASHA JACKSON, LLC NPI is 1083220453. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Sasha Jackson, Llc.
The provider's business location address is:
1212 N CALIFORNIA ST
STOCKTON, CA
ZIP 95202-552
Phone: (209) 242-0601
The provider's authorized official is Sasha Ja-nae Jackson .
The authorized official title is Owner and has the following contact phone number (209) 242-0601.
The enumeration date for this NPI number is 9/21/2020 and was last updated on 3/9/2021.