| Jackson Initiative LLC | |
|
629 Marin St Unit 4114 Vallejo CA 94590-8419 | |
| (707) 832-0174 | |
| Not Available |
| Full Name | Jackson Initiative LLC |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 629 Marin St Unit 4114, Vallejo, California |
| Authorized Official Name and Position | Amelia G Jackson (OWNER) |
| Authorized Official Contact | 7078320174 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Initiative LLC 629 Marin St Unit 4114 Vallejo CA 94590-8419 Ph: (707) 832-0174 | Jackson Initiative LLC 629 Marin St Unit 4114 Vallejo CA 94590-8419 Ph: (707) 832-0174 |
| NPI Number | 1235090515 |
|---|---|
| Provider Enumeration Date | 11/18/2025 |
| Last Update Date | 11/18/2025 |
| Certification Date | 11/18/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235090515 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | () | Secondary |
| 1041C0700X | Social Worker - Clinical | () | Primary |
| 1041S0200X | Social Worker - School | () | Secondary |
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