Miriam Denise Jackson-Hamilton, LPC
Individual provider Active NPI Professional Counselor · Rolling Fork, MS
NPI 1235776089 · NPPES record last updated Nov 27, 2019
Key facts
- NPI
- 1235776089
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 2303 (MS)
- Practice address
- 159 Parkway Ave
Rolling Fork, MS 39159-5112 - Phone
- (662) 907-1906
- NPI assigned
- Nov 27, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2303 | MS | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mended Hearts Counseling Services, LLC | Professional | Current |
Accepting new patients |
| Kidz 1St Clinic, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2303 | MS | Yes |
Addresses
Primary practice location
159 Parkway Ave
Rolling Fork, MS 39159-5112
Mailing address
159 Parkway Ave
Rolling Fork, MS 39159-5112
Phone (662) 907-1906
Other names
- Miriam Denise Jackson
Other providers in Rolling Fork, MS
- Elt Inc.
- Freds Stores of Tennessee Inc
- Martin Galas
- Andrew George
- Jackson Rural Health Clinic P a
- Danny Wade Jackson
- Patsy Johnson
- Kinetix Medical Equipment, LLC
- Olivia Gayle King
- Mended Hearts Counseling Services, LLC
All providers in Rolling Fork, MS · Professional Counselor in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.