Dewanda B. Jackson, LPC, CPCS, EAU-C

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC002390 Issued in GA

Practice address

4319 Covington Hwy Ste 110
Decatur, GA 30035-1206

Phone

(404) 286-0054

Fax

(404) 286-0064

NPI assigned

Feb 1, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Marvelous Light ConsultantsGroup PAC ID 5799030979, 2 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.

• Marvelous Light Consultants

  • Professional Counselor
  • Decatur, GA
  • NPI 1922145325
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1184761561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1501",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300581007",
            "telephone_number": "404-286-0054",
            "fax_number": "404-286-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4319 COVINGTON HWY STE 110",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300351206",
            "telephone_number": "404-286-0054",
            "fax_number": "404-286-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DEWANDA",
        "middle_name": "B.",
        "name_prefix": "Mrs.",
        "credential": "LPC, CPCS, EAU-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC002390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL COUNSELOR",
            "identifier": "LPC002390",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Althea Brenda Jackson, RN
• Amanda Z. Jackson, O.T.
• Andrea Tiggler Jackson, RPH
• Barbara Ann Jackson, RN
• Courtney Nicole Jackson
• Donna Michelle Jackson
• Emily Brockett Jackson, PHD
• Felicia Lynette Jackson, PHD
• Harold Damon Jackson, MD
• Hazel Anita Jackson, MN, RN, APRN,BC

• Professional Counselor in Decatur, GA
• Providers in Decatur, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.