Active NPI
Anthony Jackson
- Addiction (Substance Use Disorder) Counselor
- Sacramento, CA
National Provider Identifier
1245307073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 5076
- Practice address
- 2237 River Plaza Dr
Sacramento, CA 95833-3836 - Phone
- (916) 391-4293
- Fax
- (916) 391-4247
- NPI assigned
- Nov 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 5076 | CA | Primary |
Addresses
Primary practice location
2237 River Plaza Dr
Sacramento, CA 95833-3836
Mailing address
2237 River Plaza Dr
Sacramento, CA 95833-3836
Phone (916) 391-4293
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5076 | Other | CA | CAARR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5076 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245307073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2237 RIVER PLAZA DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958333836",
"telephone_number": "916-391-4293",
"fax_number": "916-391-4247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2237 RIVER PLAZA DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958333836",
"telephone_number": "916-391-4293",
"fax_number": "916-391-4247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ANTHONY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "5076",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAARR",
"identifier": "5076",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.