Individual ProviderOlivia Nicole JacksonMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address3756 Santa Rosalia Dr, Los Angeles, CA 90008-3606(323) 868-0299PECOS EnrollmentBased on the most recent information from CMS, provider Olivia Nicole Jackson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1164188231Provider TypeIndividualFull NameJackson, Olivia NicoleGenderFemaleSole ProprietorNoEnumeration Date11/12/2021Last Updated12/6/2021Contact InformationPractice LocationPractice Address3756 Santa Rosalia Dr, Los Angeles, CA 90008-3606Phone(323) 868-0299FaxUnlisted FaxMailing LocationMailing Address3756 Santa Rosalia Dr, Los Angeles, CA 90008-3606PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense129659CaliforniaCode171M00000XDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted IssuerCalifornia