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General NPI Number Information
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NPI Number | 1851423206
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Entity Type | Individual
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Provider Name | GEORGIA ANN JACKSON-THOMPSON MA
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 16090 JACKSON DRVIE
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City | FONTANA
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State | CA
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Zip | 92336
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Country | US
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Telephone | 909-429-1216
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Fax | 909-429-1216
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Provider Business Mailing Address
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Address Line | 9626 AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90003-4311
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Country | US
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Telephone | 323-779-0729
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Fax | 323-779-0739
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 40585
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License Number State | CA
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