Shyra D'Ann Jackson

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

12554-R Issued in CA

Practice address

12960 San Pablo Ave
Richmond, CA 94805-1307

Phone

(510) 215-2280

Fax

(510) 215-2283

NPI assigned

Dec 18, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ujima Family Recovery Services

  • Substance Abuse Rehabilitation Facility
  • Richmond, CA
  • NPI 1881002541
  NPD (past)
• Ujma Family Recovery Services

  • Community/Behavioral Health Agency
  • Richmond, CA
  • NPI 1134240781
  NPD (past)

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

{
    "created_epoch": "1513555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513555200000",
    "number": "1134635824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 CHURCH LN",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948063707",
            "telephone_number": "510-215-2280",
            "fax_number": "510-215-2283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12960 SAN PABLO AVE",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948051307",
            "telephone_number": "510-215-2280",
            "fax_number": "510-215-2283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHYRA",
        "middle_name": "D'ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-18",
        "last_updated": "2017-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "12554-R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel F Jackson, PHD
• Darryl I Jackson, D.C.
• George M Jackson, MD
• Leontyne Jackson
• Pasha Jackson, MD
• Trinity Ann Jackson
• Nancy Jacobson, LCSW
• John Benjamin Jakubowski, LMFT
• Jamaa Healing Collective Wellness Services
• Pauline Sandra Jarakian, MFT

• Addiction (Substance Use Disorder) Counselor in Richmond, CA
• Providers in Richmond, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2017; 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.