Carol Denise Jackson, ACADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

92151 Issued in IA

Practice address

1522 17TH Street
Des Moines, IA 50314-0000

Phone

(515) 279-0335

NPI assigned

Oct 23, 2009

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256256000000",
    "number": "1487980652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 17TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503141418",
            "telephone_number": "515-279-0335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 17TH STREET",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503140000",
            "telephone_number": "515-279-0335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CAROL",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "ACADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-23",
        "last_updated": "2009-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "92151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "X000202269",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ganesh Iyer, MD
• J&J Trans LLC
• Alec Thomas Jackson
• Beth Jackson, CRNA
• Beth Lynna Jackson, DOULA
• Craig Jackson, B.S., C.A.D.C.
• Holli Lin Jackson
• Katie Jackson
• Kelsey A Jackson
• Larry V Jackson Jr., LMHC

• Addiction (Substance Use Disorder) Counselor in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Addiction (Substance Use Disorder) Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; 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.