Provider Demographics
NPI:1770251324
Name:MIXSON, JA'CINTA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JA'CINTA
Middle Name:
Last Name:MIXSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245633
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-5633
Mailing Address - Country:US
Mailing Address - Phone:916-360-0979
Mailing Address - Fax:
Practice Address - Street 1:4818 ORTEGA ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-5828
Practice Address - Country:US
Practice Address - Phone:916-360-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25796103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist