Provider Demographics
NPI:1215064167
Name:RAHMAN-JACKSON, LISHIA KHALI II
Entity type:Individual
Prefix:MRS
First Name:LISHIA
Middle Name:KHALI
Last Name:RAHMAN-JACKSON
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 HAVENSIDE DR APT 9
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-1538
Mailing Address - Country:US
Mailing Address - Phone:916-429-0884
Mailing Address - Fax:
Practice Address - Street 1:5523 34TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4725
Practice Address - Country:US
Practice Address - Phone:916-452-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor