Valecia Jackson, CSAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

0709024300 Issued in VA

Practice address

420 Pine Ridge Rd
Petersburg, VA 23805-1320

Phone

(804) 714-5998

NPI assigned

Oct 21, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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.

• Jackson Professional Serv LLC

  • Addiction (Substance Use Disorder) Counselor
  • Petersburg, VA
  • NPI 1922761352
  NPD

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

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1306509724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 PINE RIDGE RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238051320",
            "telephone_number": "804-714-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 PINE RIDGE RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238051320",
            "telephone_number": "804-714-5998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "VALECIA",
        "credential": "CSAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0709024300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0709024300",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE ABUSE",
            "identifier": "0709024300",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackson Professional Serv LLC
• Alexandrea J Jackson, LPC
• Jasmine Shanae Jackson, NP
• Lauran Dekease Jackson
• Sara Jackson
• Rachael Jadidi, FNP
• Iteisha James-Crenshaw, LCSW
• Brianna R Jaris, PSY.D.
• Valerie L Jaskowski, FNP
• Cynthia Lynn Jenkins, PH.D.

• Addiction (Substance Use Disorder) Counselor in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Addiction (Substance Use Disorder) Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; 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.