Nicole M. Jackson, MA, LPC, LCADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37PC00345200 Issued in NJ

Practice address

232 Norwood Ave
Suite 5
West Long Branch, NJ 07764-1859

Phone

(732) 948-2132

NPI assigned

Nov 25, 2007

Last updated

Sep 29, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1195948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222646400000",
    "number": "1205017803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 NORWOOD AVE",
            "address_2": "SUITE 5",
            "city": "WEST LONG BRANCH",
            "state": "NJ",
            "postal_code": "077641859",
            "telephone_number": "732-948-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 NORWOOD AVE",
            "address_2": "SUITE 5",
            "city": "WEST LONG BRANCH",
            "state": "NJ",
            "postal_code": "077641859",
            "telephone_number": "732-948-2132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "MA, LPC, LCADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-25",
        "last_updated": "2008-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NJ",
            "license": "37PC00345200",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00119500",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00345200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in West Long Branch, NJ
• Providers in West Long Branch, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2008; 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.