Active NPI
Diane Cathleen Jackson, LCSW
- Clinical Social Worker
- Fayetteville, NC
National Provider Identifier
1194765289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C004576
- Practice address
- 806 Hay St
Fayetteville, NC 28305-5312 - Phone
- (910) 822-3333
- Fax
- (910) 822-3336
- NPI assigned
- Jun 7, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C004576 | NC | Primary |
Addresses
Primary practice location
806 Hay St
Fayetteville, NC 28305-5312
Mailing address
806 Hay St
Fayetteville, NC 28305-5312
Phone (910) 822-3333
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 136K7 | Other | NC | BCBS OF NC |
| 6003734 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C004576 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Evergreen Behavioral Management Inc | Clinical | Past | Accepting new patients |
| Hope Catchers, LLC | Past | Accepting new patients | |
| Hope Catchers, LLC | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Whiteville, NC
- NPI 1790860971
Clinical
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fayetteville, NC
- NPI 1275666539
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fayetteville, NC
- NPI 1699808584
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316995200000",
"number": "1194765289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "806 HAY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283055312",
"telephone_number": "910-822-3333",
"fax_number": "910-822-3336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "806 HAY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283055312",
"telephone_number": "910-822-3333",
"fax_number": "910-822-3336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DIANE",
"middle_name": "CATHLEEN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-07",
"last_updated": "2011-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C004576",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NC",
"identifier": "136K7",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6003734",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.