Irene Dormenie Jackson, LCMHC, LCAS-A

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

16165 Issued in NC

Practice address

904 Woodgreen Dr
Durham, NC 27704-6034

Phone

(919) 641-8358

NPI assigned

Sep 18, 2020

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

Enrolled in NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Integrative Wellness Solutions PLLCGroup PAC ID 8022341494, 143 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Integrative Wellness Solutions, PLLC

  • Psychologist
  • Mooresville, NC
  • NPI 1447760871

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1053927723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 WOODGREEN DR",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277046034",
            "telephone_number": "919-641-8358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 WOODGREEN DR",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277046034",
            "telephone_number": "919-641-8358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "IRENE",
        "middle_name": "DORMENIE",
        "credential": "LCMHC, LCAS-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-18",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-26084",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "16165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Ann Jackson, M.ED
• Christy Jackson, RD, LDN
• Delqwan Rashawn Jackson, MSW, LCSWA
• Diamond Mone Jackson, PT, DPT
• George William Jackson, MD
• Jessica Jackson, PA-C
• Joseph A. Jackson, MD
• Joshua D Jackson
• Katie Jackson, CD, LCCE
• Kevin Jevon Jackson, MD

• Mental Health Counselor in Durham, NC
• Providers in Durham, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.