Provider Demographics
NPI:1023632080
Name:JACKSON, SARA ANNE PILI (PHD, MA, LPCC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE PILI
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHD, MA, LPCC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANNE
Other - Last Name:PILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2238
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-2238
Mailing Address - Country:US
Mailing Address - Phone:714-747-9233
Mailing Address - Fax:
Practice Address - Street 1:1274 CENTER COURT DR STE 112
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3668
Practice Address - Country:US
Practice Address - Phone:626-331-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC3876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional