Active NPI
Jennifer Jackson, LCSW-A/LCAS-A
- Mental Health Counselor
- Raleigh, NC
National Provider Identifier
1366866469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- P008214
- Practice address
- 2101 Garner Rd
Raleigh, NC 27610-4687 - Phone
- (919) 832-7351
- Fax
- (919) 571-2932
- NPI assigned
- Feb 10, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3468-A | NC | |
| Mental Health Counselor | 101YM0800X | P008214 | NC | Primary |
Addresses
Primary practice location
2101 Garner Rd
Raleigh, NC 27610-4687
Mailing address
2101 Garner Rd
Raleigh, NC 27610-4687
Phone (919) 832-7351
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3468-A | NC | MD | Addiction (Substance Use Disorder) Counselor |
| P008214 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391990400000",
"number": "1366866469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 GARNER RD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276104687",
"telephone_number": "919-832-7351",
"fax_number": "919-571-2932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 GARNER RD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276104687",
"telephone_number": "919-832-7351",
"fax_number": "919-571-2932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JENNIFER",
"credential": "LCSW-A/LCAS-A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-02-10",
"last_updated": "2014-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "3468-A",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "P008214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.