Erin Shunkesha Jackson, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

4147 Issued in NC

Practice address

11330 Vanstory Dr Ste 109F
Huntersville, NC 28078-8146

Phone

(980) 705-4122

NPI assigned

Nov 17, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 13, 2026 through Jan 13, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Berkeley Community Mental Health Center

  • Exclusive Provider Organization
  • Moncks Corner, SC
  • NPI 1205065828
  NPD (past)
• South Carolina Dept of Mental Health Accounting Office

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Moncks Corner, SC
  • NPI 1508811324
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1407929151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4030 WAKE FOREST RD STE 349",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276090010",
            "telephone_number": "407-579-1771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11330 VANSTORY DR STE 109F",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280788146",
            "telephone_number": "980-705-4122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ERIN",
        "middle_name": "SHUNKESHA",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-17",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "4147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrity Wellness
• Rani Iyengar
• J Wells DDS PLLC
• J. C. Duncan DDS
• J&N Holdings Group, LLC
• Prenna Doriz Jackson
• Tarra R Jackson
• Janelle Lorraine Jahn, M.P.T.
• Jennifer Allison Jahns, PA-C
• Shailee Jain, MD

• Psychologist in Huntersville, NC
• Providers in Huntersville, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.