Justin Jackson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701008565 Issued in VA

Practice address

4212 Park Place CT
Glen Allen, VA 23060-3314

Phone

(804) 332-5950

Fax

(804) 728-1086

NPI assigned

Sep 5, 2019

Sex

Male

Sole proprietor

No

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

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Virginia Center for Addiction MedicineGroup PAC ID 4789960055, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Virginia Center for Addiction Medicine

  • Addiction Medicine (Internal Medicine) Physician
  • Glen Allen, VA
  • NPI 1477091247
  Medicare reassignment Care Compare group NPD
• Human Resources Inc

  • Substance Abuse Rehabilitation Facility
  • Richmond, VA
  • NPI 1235329756
  NPD (past)

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

{
    "created_epoch": "1567641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1235788902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4212 PARK PLACE CT",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230603314",
            "telephone_number": "804-332-5950",
            "fax_number": "804-728-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 PARK PLACE CT",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230603314",
            "telephone_number": "804-332-5950",
            "fax_number": "804-728-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JUSTIN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-05",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "VA",
            "license": "0701008565",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0701008565",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0701008565",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701008565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iron Forge Counseling
• Sherin Isaac, PMHNP-BC
• Danielle Ito, OD
• Frank P Iuorno Jr., DDS
• George Hagan Jackson, M.D.
• Michelle Maggi Jackson, FNP-C
• Valerie M. Jaeger, PNP
• James D. Cahn, DDS, P.C.
• Jeanelle James, NP
• Maria Janoschka, L.C.S.W.

• Professional Counselor in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.