Denise Diane Jackson

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

164132 Issued in OH

Practice address

4298 Rocky River Dr
Cleveland, OH 44135-1951

Phone

(216) 526-4729

Fax

(216) 781-2252

NPI assigned

Dec 27, 2017

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Front Steps Housing and Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Cleveland, OH
  • NPI 1184135519
  NPD (past)
• Front Steps Housing and Services

  • Adult Mental Health Clinic/Center
  • Cleveland, OH
  • NPI 1467981969
  NPD (past)

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

{
    "created_epoch": "1514332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1538675632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4298 ROCKY RIVER DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441351951",
            "telephone_number": "216-526-4729",
            "fax_number": "216-781-2252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4298 ROCKY RIVER DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441351951",
            "telephone_number": "216-526-4729",
            "fax_number": "216-781-2252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DENISE",
        "middle_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-27",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "164132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dai Jackson, QMHS
• Danielle N Jackson
• Darrielle Jackson
• Dayrion Jackson
• Deaunna Jackson
• Denise Marcel Jackson
• Destiny Jackson, HAS
• Diane Marie Jackson, REGISTERED NURSE
• Diane Marie Jackson, R.PH.
• Dominique Shavanta Jackson

• Addiction (Substance Use Disorder) Counselor in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; 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.