Ebony Nechole Jackson
Individual provider Active NPI Marriage & Family Therapist · Adelanto, CA
NPI 1205260486 · NPPES record last updated Mar 28, 2024
Key facts
- NPI
- 1205260486
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 122653 (CA)
- Practice address
- 11424 Chamberlaine Way
Adelanto, CA 92301-2869 - Phone
- (760) 243-0934
- NPI assigned
- Aug 24, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122653 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Citrus Counseling Services, Inc | Past |
Accepting new patients | |
| Citrus Counseling Services, Inc | Mental Health | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 122653 | CA | Yes |
Addresses
Primary practice location
11424 Chamberlaine Way
Adelanto, CA 92301-2869
Mailing address
11424 Chamberlaine Way
Adelanto, CA 92301-2869
Phone (760) 243-0934
Other providers in Adelanto, CA
- Molly Siang Boon Hanson
- House of Hope House of Faith
- Kristyn Michelle Hyatt
- Corshanae Estelle Jackson
- Dalicia Jackson
- Joseph M Molina MD Professional Corporation Southern California
- Joseph M Molina MD Professional Corporation-Southern California
- Keana Turner
- Ouk Hyun Lee
- Jessica Louisa Lester
All providers in Adelanto, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.