Provider Demographics
NPI:1215126529
Name:BURTON-JACKSON, LISA YVETTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:YVETTE
Last Name:BURTON-JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 EAST 31ST ST
Mailing Address - Street 2:ACMC HIGHLAND CAMPUS
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602
Mailing Address - Country:US
Mailing Address - Phone:510-437-4688
Mailing Address - Fax:510-437-8313
Practice Address - Street 1:1411 EAST 31ST ST
Practice Address - Street 2:ACMC HIGHLAND CAMPUS
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602
Practice Address - Country:US
Practice Address - Phone:510-437-4688
Practice Address - Fax:510-437-8313
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS176621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical