| NPI | 1083220453 |
|---|---|
| Former Legal Business Name | SASHA JACKSON, LLC |
| Entity Type | Organization |
| Authorized Contact | SASHA JA-NAE JACKSON Owner 209-242-0601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2021-03-09 |