Johnnie Mac Jackson, MSW, CSW

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

254558 Issued in KY

Practice address

7160 N Mayo TRL
Pikeville, KY 41501-3151

Phone

(606) 657-9988

NPI assigned

Jun 16, 2016

Last updated

Apr 15, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649980800000",
    "number": "1386094712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7160 N MAYO TRL",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415013151",
            "telephone_number": "606-657-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7160 N MAYO TRL",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415013151",
            "telephone_number": "606-657-9988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOHNNIE",
        "middle_name": "MAC",
        "credential": "MSW, CSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-16",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KY",
            "license": "254558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Keith Ison, D.O.
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• J. Kendall Cecil (East Kentucky Eyecare)
• Mark Jackson, P.A.
• Gabriel Jacobs, M.D.
• Brett E Jarrell, MD
• Leigh Jarrell
• Jason N Stamper DO PLLC

• Addiction (Substance Use Disorder) Counselor in Pikeville, KY
• Providers in Pikeville, KY by specialty
• Addiction (Substance Use Disorder) Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; 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.