Individual provider Active NPI

Kayla Jackson, LCSW

  • Clinical Social Worker
  • Charlottesville, VA
National Provider Identifier
1386403772
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
2340 Commonwealth Dr Ste 101
Charlottesville, VA 22901-1634
Phone
(855) 722-4422
NPI assigned
Mar 18, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

2340 Commonwealth Dr Ste 101
Charlottesville, VA 22901-1634

Mailing address

505 Main St
Toms River, NJ 08753-7443
Phone (732) 272-0127

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20260210002188 VA Practitioner - Clinical Social Worker 6507345519 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifebulb LLCGroup PAC ID 2062881162, 97 clinicians

Practice addresses (Care Compare)

2340 Commonwealth Dr
Suite 101
Charlottesville, VA 22901-1634
Phone (434) 214-6556

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling LLC CurrentSince Mar 24, 2024 Accepting new patients
Lifebulb LLC CurrentSince Dec 28, 2025 Accepting new patients

Locations

505 Main St
Toms River, NJ 08753
Phone (732) 272-0127

6210 Old Franconia Rd
#A
Alexandria, VA 22310
Phone (703) 955-3703

2340 Commonwealth Dr
Ste 101
Charlottesville, VA 22901
Phone (732) 451-3895

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1386403772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 MAIN ST",
            "city": "TOMS RIVER",
            "state": "NJ",
            "postal_code": "087537443",
            "telephone_number": "732-272-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 COMMONWEALTH DR STE 101",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229011634",
            "telephone_number": "855-722-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KAYLA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-18",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.