Ty'shunna Jackson
NPI #1154518835 in Venice, California
Provider Information
- NPI Number
- 1154518835
- Entity Type
- Individual
- Name
- Ty'shunna Jackson
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Counselor - Addiction (Substance Use Disorder)
- Enumeration Date
- Sep 26, 2007
- Last Updated
- Sep 26, 2007
Practice Location
- Address
- 717 LINCOLN BLVD
- City
- Venice
- State
- California
- ZIP Code
- 90291-2845
- Phone
- (310) 399-9883
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder) |
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