Courtney Jackson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

PO12000 Issued in NC

Practice address

3581 Lackey St
Lumberton, NC 28360-9048

Phone

(910) 738-5023

Fax

(910) 738-1451

NPI assigned

Nov 28, 2017

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Balance Beacon

  • Professional Counselor
  • Euless, TX
  • NPI 1942661327
  NPD (past)

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

{
    "created_epoch": "1511827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1043724156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3581 LACKEY ST",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283609048",
            "telephone_number": "910-738-5023",
            "fax_number": "910-738-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3581 LACKEY ST",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283609048",
            "telephone_number": "910-738-5023",
            "fax_number": "910-738-1451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 W Central St",
            "address_purpose": "LOCATION",
            "city": "Maxton",
            "state": "NC",
            "postal_code": "283641703",
            "country_code": "US",
            "telephone_number": "910-738-5023",
            "fax_number": "910-738-1451",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 Harris Ave",
            "address_purpose": "LOCATION",
            "city": "Raeford",
            "state": "NC",
            "postal_code": "283763110",
            "country_code": "US",
            "telephone_number": "910-848-2267",
            "fax_number": "910-738-1451",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "COURTNEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-28",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P012000",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "PO12000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J-Singh
• J&S Drug Company (Lumberton Drug)
• Carolyn Jackman Gordon, CRNP, PMHNP-BC
• Alicia Alexander Jackson, LCAS
• Anita Louise Jackson, M.D.
• Somariya Derika Jackson
• Staley Thomas Jackson, M.D.
• Wilton Jackson Jr.
• Allison Locklear Jacobs, FNP
• Chasity Jacobs, LMBT

• Clinical Social Worker in Lumberton, NC
• Providers in Lumberton, 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 Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.