The Source Counseling, Case Management and Consultation

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401013761 Issued in MI

Legal business name

THE SOURCE COUNSELING, CASE MANAGEMENT AND CONSULTATION

Practice address

29277 Southfield Rd Ste C
Southfield, MI 48076-1922

Phone

(313) 409-8073

NPI assigned

May 23, 2018

Organization subpart

No

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

Authorized official

Name

Shanna Jackson, LPCNPI 1922492594

Title

Owner/ Counselor

Phone

(313) 544-3513

Specialties & licenses 1

Addresses

Other names 1

• The Source Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shanna Jackson, LPC

  • Professional Counselor
  • Eastpointe, MI
  • NPI 1922492594
  NPD Authorized official

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1437640687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18007 JULIANA AVE",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480213205",
            "telephone_number": "313-544-3513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29277 SOUTHFIELD RD STE C",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480761922",
            "telephone_number": "313-409-8073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOURCE COUNSELING, CASE MANAGEMENT AND CONSULTATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-23",
        "last_updated": "2018-05-23",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SHANNA",
        "authorized_official_title_or_position": "OWNER/ COUNSELOR",
        "authorized_official_telephone_number": "313-544-3513",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401013761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Source",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• The Medicine Cabinet 2
• The Porretta Center for Orthopaedic Surgery, PLLC
• The Skin Cancer Center of SE Michigan PC
• The Social Support Network
• The Solvis Group
• The Therapeutic Loft LLC
• The Whole Listic You PLLC
• The Willing Way Counseling and Coaching Center, LLC
• The Zone Adult Day Care LLC
• Alison K Theisen, CRNA

• Professional Counselor in Southfield, MI
• Providers in Southfield, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; 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.