Active NPI
Tina E Jackson, RAS
- Addiction (Substance Use Disorder) Counselor
- Sacramento, CA
National Provider Identifier
1881809291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- C034980715
- Practice address
- 1001 Grand Ave
Sacramento, CA 95838-3512 - Phone
- (916) 929-6103
- NPI assigned
- May 11, 2007
- Sex
- Female
- Sole proprietor
- No
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 | C034980715 | CA | Primary |
Addresses
Primary practice location
1001 Grand Ave
Sacramento, CA 95838-3512
Mailing address
749 Calico Way
Oakley, CA 94561-3017
Phone (925) 679-3296
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 |
|---|---|---|---|
| C034980715 | 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": "1178841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635206400000",
"number": "1881809291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "749 CALICO WAY",
"city": "OAKLEY",
"state": "CA",
"postal_code": "945613017",
"telephone_number": "925-679-3296"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 GRAND AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958383512",
"telephone_number": "916-929-6103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TINA",
"middle_name": "E",
"name_prefix": "Mrs.",
"credential": "RAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-11",
"last_updated": "2021-10-26",
"certification_date": "2021-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "C034980715",
"primary": true
}
],
"identifiers": [],
"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 Oct 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.