Bonita Marie Jackson-Vergara, LICENSED COUNSELOR

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4804 Issued in NC

Practice address

1545 Crossways Blvd Ste 250
Chesapeake, VA 23320-0218

Phone

(704) 804-9614

NPI assigned

Jul 20, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Inova Health Care Services

  • Internal Medicine Physician
  • Falls Church, VA
  • NPI 1952320061

  DC

  Medicare reassignment NPD
• Inova Health Care Services

  • Medical Technologist
  • Sterling, VA
  • NPI 1699655589
  NPD

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1316967334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 FOX RIDGE TRL",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233226506",
            "telephone_number": "704-804-9614",
            "fax_number": "757-312-9580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 CROSSWAYS BLVD STE 250",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233200218",
            "telephone_number": "704-804-9614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11714 Spring Laurel Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282154651",
            "country_code": "US",
            "telephone_number": "704-804-9614",
            "fax_number": "980-938-8480",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "209 Research Dr",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233205995",
            "country_code": "US",
            "telephone_number": "513-834-7063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON-VERGARA",
        "first_name": "BONITA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "LICENSED COUNSELOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0718000386",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701005902",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "4804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103317",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J Dewey Willis III, D.D.S., P.C. & Assoc
• J Home Health Inc
• J.a. Rybarczyk, O.D. & Associates, P.C.
• J&J Community Services LLC
• J&L Little LLC
• Alexandria H Jackson
• Andrea Danielle Jackson, BT
• Ashantiana Wilshena, Jemila Jackson
• Brianna Jackson, RPH
• Channon Jackson

• Professional Counselor in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.