Active NPI
Jamillah A. Jackson Kelly, MS/EDS, NCC, LCMHCS
- Professional Counselor
- Durham, NC
National Provider Identifier
1235463308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 8340
- Practice address
- 4600 Emperor Blvd
Durham, NC 27703-8577 - Phone
- (919) 651-8558
- NPI assigned
- Sep 23, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 8340 | NC | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | 8340 | NC | |
| Doula | 374J00000X | |||
| Professional Counselor | 101YP2500X | 8340 | NC | Primary |
Addresses
Primary practice location
4600 Emperor Blvd
Durham, NC 27703-8577
Mailing address
329 Peach Hill LN
Holly Springs, NC 27540-5428
Phone (336) 327-7361
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 246803 | Other | NATIONAL BOARD FOR CERTIFIED COUNSELORS, INC. | |
| S8340 | Other | NC | THE NC BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS |
| 511277 | Other | NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS | |
| 8340 | Other | NC | THE NC BOARD OF LICENSED PROFESSIONAL COUNSELORS |
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)
- Not enrolled
- Credentials
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Urban Healing Counseling PLLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731974400000",
"number": "1235463308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "329 PEACH HILL LN",
"city": "HOLLY SPRINGS",
"state": "NC",
"postal_code": "275405428",
"telephone_number": "336-327-7361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4600 EMPEROR BLVD",
"city": "DURHAM",
"state": "NC",
"postal_code": "277038577",
"telephone_number": "919-651-8558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON KELLY",
"first_name": "JAMILLAH",
"middle_name": "A.",
"name_prefix": "Mrs.",
"credential": "MS/EDS, NCC, LCMHCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-23",
"last_updated": "2024-11-19",
"certification_date": "2024-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "8340",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "8340",
"primary": false
},
{
"code": "374J00000X",
"taxonomy_group": "",
"desc": "Doula",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "8340",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL BOARD FOR CERTIFIED COUNSELORS, INC.",
"identifier": "246803",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THE NC BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS",
"identifier": "S8340",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL CERTIFICATION COMMISSION FOR ADDICTION PROFESSIONALS",
"identifier": "511277",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THE NC BOARD OF LICENSED PROFESSIONAL COUNSELORS",
"identifier": "8340",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.