Provider Demographics
NPI:1548384662
Name:JACKSON, ALEXANDRA SHARON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:SHARON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 BIXBY WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1573
Mailing Address - Country:US
Mailing Address - Phone:209-477-2005
Mailing Address - Fax:209-477-2005
Practice Address - Street 1:3231 BIXBY WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1573
Practice Address - Country:US
Practice Address - Phone:209-477-2005
Practice Address - Fax:209-477-2005
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS227631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical