Provider Demographics
NPI:1326219197
Name:JACKSON, DEBORAH
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 VALENCIA ST STE 222
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3551
Mailing Address - Country:US
Mailing Address - Phone:415-864-2364
Mailing Address - Fax:415-864-0116
Practice Address - Street 1:333 VALENCIA ST STE 222
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3551
Practice Address - Country:US
Practice Address - Phone:415-864-2364
Practice Address - Fax:415-864-0116
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)