Anissa Jackson, LCDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

15987 Issued in TX

Practice address

1601 Elm St Ste 4360
Dallas, TX 75201-4701

Phone

(562) 296-2730

NPI assigned

Jun 13, 2024

Last updated

Jun 13, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1718236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1205679875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 ELM ST STE 4360",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752014701",
            "telephone_number": "562-296-2730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 ELM ST STE 4360",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752014701",
            "telephone_number": "562-296-2730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANISSA",
        "credential": "LCDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "15987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sierra Jacko
• Alaina Jacks, CAA
• Kaylee Jacks, MS, RD, CSSD, LD
• Shanda Jackson-Brown
• Yolanda Juanitha Jackson-Taylor, DMD
• Anna Jackson, LPC-A
• Ashley Jackson, LCSW
• Ashley Nichole Jackson, LMFT, PCC-A
• Azariah Jackson
• Breonka Latroya Jackson, DC

• Addiction (Substance Use Disorder) Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Addiction (Substance Use Disorder) Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.