Active NPI
Mary H. Jackson, LPC
- Professional Counselor
- Metter, GA
National Provider Identifier
1578623955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1843
- Practice address
- Route 1
Metter, GA 30439 - Phone
- (912) 685-6545
- Fax
- (912) 685-6545
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1843 | GA | Primary |
Addresses
Primary practice location
Route 1
Metter, GA 30439
Mailing address
RR 1 Box 298
Metter, GA 30439-9703
Phone (912) 685-6545
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 |
|---|---|---|---|
| 1843 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1578623955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 1 BOX 298",
"city": "METTER",
"state": "GA",
"postal_code": "304399703",
"telephone_number": "912-685-6545",
"fax_number": "912-685-6545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ROUTE 1",
"city": "METTER",
"state": "GA",
"postal_code": "30439",
"telephone_number": "912-685-6545",
"fax_number": "912-685-6545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARY",
"middle_name": "H.",
"name_prefix": "Dr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "1843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Metter, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.