Chemara Jackson, ED.D., LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC008086 Issued in GA

Practice address

4845 Locherby Dr
Fairburn, GA 30213-4385

Phone

(404) 754-2989

NPI assigned

Dec 11, 2014

Last updated

Jan 23, 2017By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Liberation Works LLC

  • Professional Counselor
  • Fairburn, GA
  • NPI 1639618648
  NPD (past) Authorized official

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

{
    "created_epoch": "1418256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485129600000",
    "number": "1265830954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4845 LOCHERBY DR",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302134385",
            "telephone_number": "404-754-2989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4845 LOCHERBY DR",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302134385",
            "telephone_number": "404-754-2989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHEMARA",
        "credential": "ED.D., LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-11",
        "last_updated": "2017-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC008086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003140046A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roderick Elliott Howard, AM
• Terrell Humphries
• I Deserve Mental Wellness Services
• Independent Physical Therapy, LLC (BenchMark GA)
• Jackson Family Eye Care, LLC (Jackson Eye)
• Trevis Shantell Jackson
• Jeane Watson DPM LLC
• Kendra Jenkins
• Jervon D Hamilton Counseling
• April Means Johnson, COTA/L

• Professional Counselor in Fairburn, GA
• Providers in Fairburn, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; 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.