Deforrest Kwesi Jackson, CADC-1

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

T-20-047 Issued in OR

Practice address

12670 NW Barnes Rd Ste 200
Portland, OR 97229-9001

Phone

(971) 232-3850

NPI assigned

Feb 3, 2020

Sex

Male

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

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.

• Another Chance Clinical Services LLC

  • Community/Behavioral Health Agency
  • Portland, OR
  • NPI 1811572860
  NPD

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

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1194356618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 SE 90TH AVE APT 1424",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970862626",
            "telephone_number": "503-432-7975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12670 NW BARNES RD STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972299001",
            "telephone_number": "971-232-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DEFORREST",
        "middle_name": "KWESI",
        "credential": "CADC-1",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-03",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "T-20-047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Jackson
• Christine Wilkes Jackson, PSY.D.
• Christopher Jackson, MD
• Constance Janene Jackson, MD
• Courtney Brooke Jackson, N.D.
• Dejia Jackson
• Donald Jackson
• Elijah Jackson
• Erika Jackson, MS
• Heather Jackson

• Addiction (Substance Use Disorder) Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; 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.