Deja Jackson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

IMH25319 Issued in FL

Practice address

2425 S Park Ave
Sanford, FL 32771-4419

Phone

(689) 247-7243

NPI assigned

Jun 13, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1718236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1114760774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 ABBEYWOOD LN",
            "city": "CASSELBERRY",
            "state": "FL",
            "postal_code": "327075933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 S PARK AVE",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327714419",
            "telephone_number": "689-247-7243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DEJA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH25319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrated Regional Laboratories Pathology Services, LLC
• Integrative Physical Medicine of Sanford, LLC
• Xenie Ivancova, M.D.
• J D Mobile Health Services Inc
• Bernadete Jackson
• Kimcheree Jackson
• Taiwan Jackson, LPN
• Christina Jacob, PA-C
• Thomas Jacobson
• Ram N Jadon, APRN

• Mental Health Counselor in Sanford, FL
• Providers in Sanford, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.