Active NPI
Cherina Laquelle Jackson, LMSW, CSW INTERN
- Clinical Social Worker
- Las Vegas, NV
National Provider Identifier
1578299137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 9805-M
- Practice address
- 2500 Chandler Ave Ste 3
Las Vegas, NV 89120-4064 - Phone
- (725) 204-8809
- NPI assigned
- Jul 26, 2022
- Last updated
- Jul 26, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 9805-M | NV | Primary |
Addresses
Primary practice location
2500 Chandler Ave Ste 3
Las Vegas, NV 89120-4064
Mailing address
2500 Chandler Ave Ste 3
Las Vegas, NV 89120-4064
Phone (725) 204-8809
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
| License | State | Type | Specialty |
|---|---|---|---|
| 9805-M | NV | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| FDV Wellness Center | Clinical | Current | Accepting new patients |
Locations
2500 Chandler Ave
Ste 3
Las Vegas, NV 89120
Phone (725) 204-8809
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658793600000",
"number": "1578299137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 CHANDLER AVE STE 3",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891204064",
"telephone_number": "725-204-8809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 CHANDLER AVE STE 3",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891204064",
"telephone_number": "725-204-8809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHERINA",
"middle_name": "LAQUELLE",
"credential": "LMSW, CSW INTERN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-26",
"last_updated": "2022-07-26",
"certification_date": "2022-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NV",
"license": "9805-M",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.