Active NPI
Marta Jackson, MA, MS, LCMHC
- Mental Health Counselor
- Raleigh, NC
National Provider Identifier
1396179081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 11114
- Practice address
- 4090 Barrett Dr
Raleigh, NC 27609-6604 - Phone
- (919) 925-2266
- NPI assigned
- Aug 29, 2013
- Last updated
- Jan 7, 2021
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | SWP-LCPC-LIC-4600 | MT | |
| Mental Health Counselor | 101YM0800X | 11114 | NC | Primary |
Addresses
Primary practice location
4090 Barrett Dr
Raleigh, NC 27609-6604
Mailing address
4090 Barrett Dr
Raleigh, NC 27609-6604
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)
- Not enrolled
- Credentials
- Master of Arts, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SWP-LCPC-LIC-4600 | MT | MD | Mental Health Counselor |
| 11114 | NC | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609977600000",
"number": "1396179081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4090 BARRETT DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276096604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4090 BARRETT DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276096604",
"telephone_number": "919-925-2266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARTA",
"credential": "MA, MS, LCMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-29",
"last_updated": "2021-01-07",
"certification_date": "2021-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MT",
"license": "SWP-LCPC-LIC-4600",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "11114",
"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 Jan 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.