Active NPI
Kendra Lorraine Jackson, LPC
- Professional Counselor
- Annapolis, MD
National Provider Identifier
1306126867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC14199
- Practice address
- 2525 Riva Rd Ste 142
Annapolis, MD 21401-7411 - Phone
- (443) 221-7189
- NPI assigned
- Aug 27, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LGP3952 | MD | |
| Professional Counselor | 101YP2500X | LPC14199 | DC | Primary |
Addresses
Primary practice location
2525 Riva Rd Ste 142
Annapolis, MD 21401-7411
Mailing address
2525 Riva Rd Ste 142
Annapolis, MD 21401-7411
Phone (443) 221-7189
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 |
|---|---|---|---|
| LGP3952 | MD | MD | Counselor |
| LPC14199 | DC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335225600000",
"number": "1306126867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 RIVA RD STE 142",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214017411",
"telephone_number": "443-221-7189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 RIVA RD STE 142",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214017411",
"telephone_number": "443-221-7189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KENDRA",
"middle_name": "LORRAINE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-27",
"last_updated": "2012-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MD",
"license": "LGP3952",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "DC",
"license": "LPC14199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annapolis, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.