Lora J Jackson, MS, LPC, NCC
Individual provider Active NPI Counselor · Everett, PA
NPI 1013228519 · NPPES record last updated Jun 29, 2010
Key facts
- NPI
- 1013228519
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- PC005514 (PA)
- Practice address
- 110 W Main St
Everett, PA 15537-1131 - Phone
- (814) 652-2650
- NPI assigned
- Jun 29, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC2939 | MD | MD | Counselor |
| PC005514 | PA | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | PC005514 | PA | Yes |
| Counselor | 101Y00000X | LC2939 | MD |
Addresses
Primary practice location
110 W Main St
Everett, PA 15537-1131
Mailing address
PO Box 398
10309 Greenwood Street
Ellerslie, MD 21529-0398
Phone (301) 697-6199
Other providers in Everett, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.