Active NPI
Conswaila Jackson, CADCII
- Addiction (Substance Use Disorder) Counselor
- Torrance, CA
National Provider Identifier
1265563258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- A2008005
- Practice address
- 21730 S Vermont Ave Ste 210
Torrance, CA 90502-2196 - Phone
- (310) 781-3408
- NPI assigned
- Mar 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | A2008005 | CA | Primary |
Addresses
Primary practice location
21730 S Vermont Ave Ste 210
Torrance, CA 90502-2196
Mailing address
21730 S Vermont Ave Ste 210
Torrance, CA 90502-2196
Phone (310) 781-3400
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 |
|---|---|---|---|
| A2008005 | 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": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686182400000",
"number": "1265563258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21730 S VERMONT AVE STE 210",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905022196",
"telephone_number": "310-781-3400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21730 S VERMONT AVE STE 210",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905022196",
"telephone_number": "310-781-3408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CONSWAILA",
"credential": "CADCII",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-08",
"last_updated": "2023-06-08",
"certification_date": "2023-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "A2008005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Torrance, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.