Healthcare Provider Details

I. General information

NPI: 1902947229
Provider Name (Legal Business Name): LYNOR ELIZABETH JACKSON-MARKS L.C.S.W., PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 BISSO LN STE 280
CONCORD CA
94520-4860
US

IV. Provider business mailing address

2425 BISSO LANE 280
CONCORD CA
94520
US

V. Phone/Fax

Practice location:
  • Phone: 925-646-5246
  • Fax: 925-646-5662
Mailing address:
  • Phone: 925-646-5246
  • Fax: 925-646-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW16536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: