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General NPI Number Information
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NPI Number | 1669571956
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Entity Type | Individual
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Provider Name | TORCHESSA LA'VETTA WEST-JACKSON DR.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 5201 GREAT AMERICA PKWY STE 320
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City | SANTA CLARA
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State | CA
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Zip | 95054-1140
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5571
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City | AUGUSTA
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State | GA
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Zip | 30916-5571
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Country | US
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Telephone | 706-830-1240
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L13177
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License Number State | OR
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