Joshua Jackson

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDCA.180460 Issued in OH

Practice address

3103 Dixie Hwy
Hamilton, OH 45015-1653

Phone

(513) 892-4673

Fax

(513) 737-1107

NPI assigned

Feb 24, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

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.

• Decoach Team LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Cincinnati, OH
  • NPI 1366992224

  Rehabilitation, Substance Use Disorder

  NPD
• Decoach Team LLC

  • Adult Mental Health Clinic/Center
  • Cincinnati, OH
  • NPI 1578037552
  NPD

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

{
    "created_epoch": "1614124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1225622814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 DIXIE HWY",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450151653",
            "telephone_number": "513-892-4673",
            "fax_number": "513-737-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 DIXIE HWY",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450151653",
            "telephone_number": "513-892-4673",
            "fax_number": "513-737-1107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "446 Morgan St",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452062348",
            "country_code": "US",
            "telephone_number": "833-510-4357",
            "fax_number": "866-459-6532",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOSHUA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-24",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.180460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antonia Jackson
• Cynthia Lee Jackson, LPN
• Dominiqe Alexis Jackson
• Hannah Jackson, OTR/L
• Jacqueline E Jackson, BSW
• Mariah S Jackson
• Rachelle Jackson
• Tiffany Renee Jackson, CDCA,CCHW
• Deanne Renee Jacobs, MD
• Denise Marie Jaeger, OTRL

• Addiction (Substance Use Disorder) Counselor in Hamilton, OH
• Providers in Hamilton, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.