Jacklyn Simon, LPC, CSOTP, CCTP

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701006044 Issued in VA

Practice address

4901 E Patrick Henry Hwy
Burkeville, VA 23922-3454

Phone

(434) 767-7801

NPI assigned

Apr 3, 2020

Last updated

Apr 3, 2020By the provider in NPPES

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

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585872000000",
    "number": "1326677287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 LEW JONES RD",
            "city": "ALBERTA",
            "state": "VA",
            "postal_code": "238212609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 E PATRICK HENRY HWY",
            "city": "BURKEVILLE",
            "state": "VA",
            "postal_code": "239223454",
            "telephone_number": "434-767-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "JACKLYN",
        "credential": "LPC, CSOTP, CCTP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-03",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701006044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; 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.