Terrie Jackson, CDCA / PEER SUPPORT

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

0002374 Issued in OH

Practice address

2800 Riverside Ave
Cleveland, OH 44109-2324

Phone

(216) 246-7081

NPI assigned

Apr 16, 2021

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

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/brileysoberhome/r4/

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.

• B. Riley Sober House

  • Addiction (Substance Use Disorder) Counselor
  • Cleveland, OH
  • NPI 1124592894
  NPD (past)

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

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1134700677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3719 DENISON AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441092691",
            "telephone_number": "216-417-4831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 RIVERSIDE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441092324",
            "telephone_number": "216-246-7081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TERRIE",
        "credential": "CDCA / PEER SUPPORT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-16",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "0002374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tahzane Jackson
• Tanisha Jackson
• Tasia Kiara Jackson
• Tedra Jackson
• Teisha Jackson
• Thisia Sean Jackson
• Tishanna Shyriece Jackson
• Toni Jackson, CPST
• Torri Lyn Jackson
• Tracy Jackson

• Peer Specialist in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Peer Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; 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.