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KEVIN JACKSON SR.
NPI 1164845400
Counselor - Addiction (Substance Use Disorder) in San Bernardino, CA

Active since January 22, 2014
621 E CARNAGIE DR # 210 SAN BERNARDINO CA 92415, SAN BERNARDINO, CA 92415(909) 386-9767(909) 381-2172 Get Directions Write a Review

NPPES record last updated: January 14, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kevin Jackson Sr. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEVIN JACKSON SR. (NPI 1164845400) is an individual addiction (substance use disorder) provider in San Bernardino, California and active in the NPI registry since January 2014.

NPPES Registry Identity

NPI1164845400
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameKEVIN JACKSON SR.
Location Address621 E CARNAGIE DR # 210 SAN BERNARDINO CA 92415San Bernardino, CA 92415-3919
Mailing Address621 E Carnagie Dr # 210 San Bernardino Ca 92415San Bernardino, CA 92415-0530 · (909) 386-9767 · Fax (909) 381-2172
Phone(909) 386-9767
Fax(909) 381-2172
Sole ProprietorNo
Enumeration DateJanuary 22, 2014
Last NPPES UpdateJanuary 14, 2020
✔ NPI 1164845400 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
621 E CARNAGIE DR # 210 SAN BERNARDINO CA 92415, San Bernardino, CA 92415
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kevin Jackson's NPI number?

The NPI number for Kevin Jackson is 1164845400. It was assigned to this individual provider in the NPPES registry on January 22, 2014.

Where is Kevin Jackson located?

Kevin Jackson practices at 621 E Carnagie Dr # 210 San Bernardino Ca 92415, San Bernardino, CA 92415. The listed phone number is (909) 386-9767.

What is Kevin Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Kevin Jackson was last updated on January 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.