Active NPI
Blaire Jackson, CAC
- Addiction (Substance Use Disorder) Counselor
- Tampa, FL
National Provider Identifier
1245599547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CAC 1335
- Practice address
- 5707 N 22ND St
Tampa, FL 33610-4350 - Phone
- (813) 239-8069
- Fax
- (813) 239-8514
- NPI assigned
- May 8, 2012
- Last updated
- Jul 14, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CAC 1335 | LA | Primary |
Addresses
Primary practice location
5707 N 22ND St
Tampa, FL 33610-4350
Mailing address
5707 N 22ND St
Tampa, FL 33610-4350
Phone (813) 239-8069
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CAC 1335 | LA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436832000000",
"number": "1245599547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5707 N 22ND ST",
"city": "TAMPA",
"state": "FL",
"postal_code": "336104350",
"telephone_number": "813-239-8069",
"fax_number": "813-239-8514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5707 N 22ND ST",
"city": "TAMPA",
"state": "FL",
"postal_code": "336104350",
"telephone_number": "813-239-8069",
"fax_number": "813-239-8514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BLAIRE",
"name_prefix": "Mr.",
"credential": "CAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-05-08",
"last_updated": "2015-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "LA",
"license": "CAC 1335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.