| Doctor Name: | MS. TONI LOUISE JACKSON |
| NPI Number: | 1588053342 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 4912-R |
| Business Practice Address: | 1796 Bay Rd East Palo Alto, CA - 943031611 |
| Business Phone Number: | 6504626999 |
| Business Fax Number: | 6504621055 |
| Mailing Address: | 1796 Bay Rd, EAST PALO ALTO |
| State: | CA |
| Postal Code: | 943031611 |
| Phone Number: | 6504626999 |
| Fax Number: | 6504621055 |
| NPI Enumeration Date: | 01/16/2015 |
| NPI Last Update Date: | 09/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 4912-R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |