Natacha Jackson

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

001179 Issued in CT

Practice address

180 Fairfield Ave
Bridgeport, CT 06604-4252

Phone

(203) 394-6529

NPI assigned

Apr 11, 2016

Sex

Female

Sole proprietor

No

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

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.

• Procare Counseling CT, LLC

  • Addiction (Substance Use Disorder) Counselor
  • Hartford, CT
  • NPI 1093451148
  NPD Authorized official
• Revive Wellness LLC

  • Clinical Social Worker
  • Naugatuck, CT
  • NPI 1235884073
  NPD (past)

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

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460332800000",
    "number": "1285098798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 FAIRFIELD AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066044252",
            "telephone_number": "203-394-6529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 FAIRFIELD AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066044252",
            "telephone_number": "203-394-6529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NATACHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-11",
        "last_updated": "2016-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "001179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iya Therapy and Wellness PLLC
• Sumedh Krishna Iyengar, MD
• Jackqueline McLean DDS LLC
• Juliet Alexandra Jackson, MD
• Marcus Kirk Jackson, LCSW
• Samyiah Destiny Jackson
• Tatiana Y Jackson
• Jack Jacob, D.O.
• Jean K Jacob, PHARM.D.
• Juliet Jacob

• Addiction (Substance Use Disorder) Counselor in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Addiction (Substance Use Disorder) Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; 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.