Active NPI
Georgia Ann Jackson-Thompson, MA
- Mental Health Counselor
- Fontana, CA
National Provider Identifier
1851423206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 40585
- Practice address
- 16090 Jackson Drvie
Fontana, CA 92336 - Phone
- (909) 429-1216
- Fax
- (909) 429-1216
- NPI assigned
- Mar 12, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 40585 | CA | Primary |
Addresses
Primary practice location
16090 Jackson Drvie
Fontana, CA 92336
Mailing address
9626 Avalon Blvd
Los Angeles, CA 90003-4311
Phone (323) 779-0729
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40585 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1851423206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9626 AVALON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900034311",
"telephone_number": "323-779-0729",
"fax_number": "323-779-0739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16090 JACKSON DRVIE",
"city": "FONTANA",
"state": "CA",
"postal_code": "92336",
"telephone_number": "909-429-1216",
"fax_number": "909-429-1216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON-THOMPSON",
"first_name": "GEORGIA",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-12",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "40585",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.