NPIMap

Individual provider Active NPI

Shakiatra Jackson

  • Mental Health Counselor
  • Columbus, GA
National Provider Identifier
1558022368
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
APC008775 Issued in GA
Practice address
1727 Boxwood PL
Columbus, GA 31906-2328
Phone
(706) 569-0727
NPI assigned
Jan 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Mental Health Counselor 101YM0800X APC008775 GA Primary

Addresses

Primary practice location

1727 Boxwood PL
Columbus, GA 31906-2328

Mailing address

1110 13TH St # D
Columbus, GA 31901-2246
Phone (706) 780-1704

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

State licenses

LicenseStateTypeSpecialty
APC008775GAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
New Horizons CSB Midtown Recovery PastSince Jan 15, 2023 Accepting new patients
Zoe Center for ABA and Development Services, LLC PastSince Jan 1, 2022 Accepting new patients
Project Change Clubhouse PastSince Jan 15, 2023 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1558022368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 13TH ST # D",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319012246",
            "telephone_number": "706-780-1704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 BOXWOOD PL",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319062328",
            "telephone_number": "706-569-0727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHAKIATRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-04",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "APC008775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.