Provider Demographics
NPI:1790827384
Name:JACKS, JODINA (MS)
Entity Type:Individual
Prefix:MISS
First Name:JODINA
Middle Name:
Last Name:JACKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TOWN AND COUNTRY DR STE A
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3960
Mailing Address - Country:US
Mailing Address - Phone:925-837-0505
Mailing Address - Fax:925-837-0568
Practice Address - Street 1:115 TOWN AND COUNTRY DR STE A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3960
Practice Address - Country:US
Practice Address - Phone:925-837-0505
Practice Address - Fax:925-837-0568
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist