Davetta Jackson-Young

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

00320397 Issued in CA

Practice address

8863 Santa Maria Way
Stockton, CA 95210-1145

Phone

(678) 704-5213

NPI assigned

Jul 31, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Davetta Jackson-Young Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406764800000",
    "number": "1023426228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8863 SANTA MARIA WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95210",
            "telephone_number": "678-704-5213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8863 SANTA MARIA WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952101145",
            "telephone_number": "678-704-5213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-YOUNG",
        "first_name": "DAVETTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-31",
        "last_updated": "2014-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "00320397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAVETTA",
            "last_name": "JACKSON-YOUNG",
            "credential": "CLINICIAN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jaicharan J. Iyengar, M.D.
• J & R Transportation
• J & R Transportation
• J. Lawrence Depolo M.D., Inc.
• Joseph Michael Jackson Pointon
• Alexandra Sharon Jackson, LCSW
• Alicia M. Jackson
• Ariyah Jackson, BA
• Brigee Jannese Jackson, PSY.D.
• Danielle Jackson

• Marriage & Family Therapist in Stockton, CA
• Providers in Stockton, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.