Provider Demographics
NPI:1609005172
Name:JACKSON, PAUL A JR (MA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 ANDREA BLVD
Mailing Address - Street 2:SUITE 86
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-2518
Mailing Address - Country:US
Mailing Address - Phone:480-322-9955
Mailing Address - Fax:
Practice Address - Street 1:5117 ANDREA BLVD
Practice Address - Street 2:SUITE 86
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95842-2518
Practice Address - Country:US
Practice Address - Phone:480-322-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor