Emily Nanette Jackson, LPC, NCC, CSOTS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC006931 Issued in GA

Practice address

200 N Lewis St
Lagrange, GA 30240-2738

Phone

(706) 887-5787

Fax

(706) 780-5402

NPI assigned

Jan 20, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Enj Counseling, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lagrange, GA
  • NPI 1902320542
  NPD Authorized official
• Jasmine Naheed, MDPC, LLC

  • Psychiatry Physician
  • Lagrange, GA
  • NPI 1952602823
  NPD (past)

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

{
    "created_epoch": "1327017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583280000000",
    "number": "1386915494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N LEWIS ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402738",
            "telephone_number": "706-887-5787",
            "fax_number": "706-780-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N LEWIS ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402738",
            "telephone_number": "706-887-5787",
            "fax_number": "706-780-5402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EMILY",
        "middle_name": "NANETTE",
        "credential": "LPC, NCC, CSOTS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-20",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC006931",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC006931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003215089A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard L Ingram, MD
• Innovative Dialysis Centers of la Grange, LLC
• Emmanuela Onyinyechi Irebuisi, NP
• Jackson & Jackson Dental, LLP
• Christina Marie Jackson, OTR/L
• John M Jackson Jr., DMD
• John Morgan Jackson III, DMD
• Tanisha Jackson
• Chloe Beall Jacobs, PA-C
• Mykle A Jacobs, D.D.S.

• Professional Counselor in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.