Provider Demographics
NPI:1427633346
Name:JACKSON, ZACHARY D
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:D
Last Name:JACKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 LORRAINE AVE
Mailing Address - Street 2:1/2
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1031
Mailing Address - Country:US
Mailing Address - Phone:805-345-9702
Mailing Address - Fax:
Practice Address - Street 1:1020 PLACIDA PL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3684
Practice Address - Country:US
Practice Address - Phone:805-963-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)