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General NPI Number Information
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NPI Number | 1023632080
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Entity Type | Individual
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Provider Name | SARA ANNE PILI JACKSON PH.D, MA, LPCC
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Gender | Female
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1274 CENTER COURT DR STE 112
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City | COVINA
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State | CA
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Zip | 91724-3668
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Country | US
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Telephone | 626-331-8177
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2238
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City | LA HABRA
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State | CA
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Zip | 90632-2238
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Country | US
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Telephone | 714-747-9233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC3876
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License Number State | CA
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