Provider Demographics
NPI:1801816244
Name:JACKSON, ALEXANDER ENACIO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:ENACIO
Last Name:JACKSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 PARK BOULEVARD WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2837
Mailing Address - Country:US
Mailing Address - Phone:510-530-0767
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE
Practice Address - Street 2:SUITE 125-D, ALAMEDA COUNTY BHCS
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-777-3877
Practice Address - Fax:510-777-3880
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS191961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical