Provider Demographics
NPI:1720235476
Name:JACKSON, YVETTE ANTOINETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:ANTOINETTE
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 1:400 CORPORATE POINTE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7620
Mailing Address - Country:US
Mailing Address - Phone:323-298-0752
Mailing Address - Fax:323-298-5893
Practice Address - Street 1:400 CORPORATE POINTE
Practice Address - Street 2:SUITE 300
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7620
Practice Address - Country:US
Practice Address - Phone:323-298-0752
Practice Address - Fax:323-298-5893
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical