NPIMap

Lisa Nanches Jackson

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Washington, DC

NPI 1376236281 · NPPES record last updated Dec 3, 2024

Key facts

NPI
1376236281
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
CACII1408 (DC)
Practice address
920 Bellevue St SE
Washington, DC 20032-6030
Phone
(202) 562-4939
NPI assigned
May 29, 2023
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
CACII1408DCMDAddiction (Substance Use Disorder) Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X
Addiction (Substance Use Disorder) Counselor 101YA0400X CACII1408 DC Yes

Addresses

Primary practice location

920 Bellevue St SE
Washington, DC 20032-6030

Mailing address

920 Bellevue St SE
Washington, DC 20032-6030

Other identifiers

IdentifierTypeStateIssuer
CACII1408OtherDCCAC II

Other providers in Washington, DC

All providers in Washington, DC · Addiction (Substance Use Disorder) Counselor in District of Columbia

Sources for this page

Verify at the official NPI Registry.