Gabriella T Jack, NCC, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0701010212 Issued in VA

Practice address

9301 Santayana Dr
Fairfax, VA 22031-3069

Phone

(571) 502-8362

NPI assigned

Feb 18, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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": "1613606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1174116248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9301 SANTAYANA DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220313069",
            "telephone_number": "571-502-8362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9301 SANTAYANA DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220313069",
            "telephone_number": "571-502-8362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "GABRIELLA",
        "middle_name": "T",
        "credential": "NCC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0701010212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.betterhelp.com/account/",
            "affiliation": "N",
            "endpointDescription": "on line counseling",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9301 Santayana Dr",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220313069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• J&C Healthcare LLC
• Rolla Jaber, M.D.
• Jessica Jabola, MD
• Ruby Rosa P Jacinto, NP
• Jack M. Costa, M.D., P.C.
• Beth Jackson, MSW, M.ED.
• Charles E. Jackson, FNP-C
• Claressa O Jackson, OTR/L
• Cynthia M Jackson
• Emily Gigena Jackson

• Mental Health Counselor in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 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.