Quatysha N Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904010951 Issued in VA

Practice address

112 S Providence Rd Ste 201
North Chesterfield, VA 23236-3300

Phone

(804) 822-0236

NPI assigned

Jul 8, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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.

• Breaking the Cycle, LLC

  • Community/Behavioral Health Agency
  • North Chesterfield, VA
  • NPI 1689397523
  NPD Authorized official
• Alliance Family Counseling Group

  • Community/Behavioral Health Agency
  • North Chesterfield, VA
  • NPI 1649612029
  NPD (past)

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

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1245892579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 S PROVIDENCE RD STE 201",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232363300",
            "telephone_number": "804-822-0236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 S PROVIDENCE RD STE 201",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232363300",
            "telephone_number": "804-822-0236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "QUATYSHA",
        "middle_name": "N",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-08",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904010951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelette Jackson, NP
• Emily Jackson
• Hannah Kioko Jackson
• John Martin Jackson
• Naomi Martina Jackson, LCSW
• Harvey Earl Jacobs, PH.D.
• Rebecca Jacobson-Fowler, LMT
• Joseph Jadallah, PHARMD
• Jade ABA Therapy LLC
• Ehsan Jafree

• Clinical Social Worker in North Chesterfield, VA
• Providers in North Chesterfield, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.

Verify at the official NPI Registry.