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1699483040
WANDA LAVINA JACKSON
SACRAMENTO, CA
NPI
1699483040
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA B0000390819)
Enumeration Date
2022-11-14
Last Update Date
2022-11-14
Business Address
WANDA LAVINA JACKSON
4441 AUBURN BLVD STE E
SACRAMENTO, CA 95841-4139
Phone number: 916-473-5764
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Mailing Address
WANDA LAVINA JACKSON
4441 AUBURN BLVD STE E
SACRAMENTO, CA 95841-4139
Phone number: 916-473-5764
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