Katherine Jackson, MA, LMFTA

Primary specialty

CounselorTaxonomy code 101Y00000X

License

12495A Issued in NC

Practice address

6604 Six Forks Rd
Raleigh, NC 27615-6521

Phone

(919) 725-8086

NPI assigned

Dec 22, 2022

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1671667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1265144000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10204 RIVER BANK DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148928",
            "telephone_number": "919-332-1517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6604 SIX FORKS RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276156521",
            "telephone_number": "919-725-8086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "MA, LMFTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-22",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "12495A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "12495A",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "TherapyNotes",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EHR",
            "address_1": "6604 Six Forks Rd",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276156521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David Jackson, DDS
• Elizabeth Wood Jackson, PH.D.
• Grace Glasgow Jackson, LCSWA, LCASA
• Jasmine Tiana Jackson
• Jennifer Jackson, LCSW-A/LCAS-A
• Kathleen Maeve Jackson
• Katti Laine Jackson, MS, RD, LDN
• Kendra D Jackson
• Krystal Kiamon Jackson
• Latrina Colleen Jackson, RN

• Counselor in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; 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.