Charles Bartlett Jackson Jr.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C007168 Issued in NC

Practice address

355 S Madison Blvd Ste C1
Roxboro, NC 27573-5485

Phone

(336) 599-8366

Fax

(336) 322-6168

NPI assigned

Sep 9, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Freedom House Recovery Center, Inc.

  • Community/Behavioral Health Agency
  • Roxboro, NC
  • NPI 1093986523
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441497600000",
    "number": "1003149048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 S MADISON BLVD STE C1",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275735485",
            "telephone_number": "336-599-8366",
            "fax_number": "336-322-6168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 S MADISON BLVD STE C1",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275735485",
            "telephone_number": "336-599-8366",
            "fax_number": "336-322-6168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHARLES",
        "middle_name": "BARTLETT",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-09",
        "last_updated": "2015-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C007168",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1513",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6112139",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Insight Awaken PLLC
• Integrative Communtiy Solutions, LLC
• J-1 Consultants LLC
• J-1 Consultants LLC
• Brianna Elizabeth Jackson
• Erin Atwater Jackson, OD
• Nathan Oscar Jackson, MD
• James R Devillier MD PC
• Rebecca Jean Baptiste
• Matthew Jennings, MSSW

• Clinical Social Worker in Roxboro, NC
• Providers in Roxboro, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.