Angela Decarla Jackson, PH.D., LCPC, LMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

39004648A Issued in IN

Practice address

1251 N Eddy St Ste 200
South Bend, IN 46617-1478

Phone

(312) 798-9755

NPI assigned

Nov 17, 2016

Sex

Female

Sole proprietor

No

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 IN, IL2 enrollments

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 2

Specialty

Mental Health Counselor

Education

Other, 2004

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  IL, IN

  Medicare reassignment NPD
• Culturally Competent Therapy PLLC

  • Professional Counselor
  • South Bend, IN
  • NPI 1881215374

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1479340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1194267476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1251 N EDDY ST STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171478",
            "telephone_number": "312-798-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 N EDDY ST STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171478",
            "telephone_number": "312-798-9755"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1251 N Eddy St Ste 200",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466171478",
            "country_code": "US",
            "telephone_number": "312-798-9755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANGELA",
        "middle_name": "DECARLA",
        "name_prefix": "Dr.",
        "credential": "PH.D., LCPC, LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-17",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.011258",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IN",
            "license": "39004648A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melyse Blandine Ishimwe
• Chloe Itimu
• Patrice Ivory-Butler, LLMSW
• Kimberly Jabian, RBT
• Amar Zierre Jackson
• Annitta Jackson, LPN
• Dandray Isaiah Jackson I
• Joann Michelle Jackson, PSY.D.
• Markus K Jackson, LCSW
• Matthew Jackson

• Professional Counselor in South Bend, IN
• Providers in South Bend, IN by specialty
• Professional Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; 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.