Provider Demographics
NPI:1295365039
Name:JACKSON GARCIA, SARAH MICHELLE (AMFT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELLE
Last Name:JACKSON GARCIA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MICHELLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:10331 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-6351
Mailing Address - Country:US
Mailing Address - Phone:714-663-6000
Mailing Address - Fax:
Practice Address - Street 1:11271 STANFORD AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5317
Practice Address - Country:US
Practice Address - Phone:714-663-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127607106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist