Jacksons Jubilee LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

JACKSONS JUBILEE LLC

Practice address

4317 Harford Rd
Baltimore, MD 21214-3118

Phone

(443) 653-9506

Fax

(410) 275-0992

NPI assigned

Jan 2, 2026

Last updated

Jan 2, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samantha JacksonNPI 1609438225

Title

Ceo

Phone

(443) 653-9506

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samantha Lachelle Jackson, LCPC

  • Professional Counselor
  • Baltimore, MD
  • NPI 1609438225
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1767312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767312000000",
    "number": "1588520563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4317 HARFORD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212143118",
            "telephone_number": "443-653-9506",
            "fax_number": "410-275-0992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4317 HARFORD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212143118",
            "telephone_number": "443-653-9506",
            "fax_number": "410-275-0992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONS JUBILEE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-02",
        "last_updated": "2026-01-02",
        "certification_date": "2026-01-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "443-653-9506"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Traci Jackson, M.S.
• Tysheka Jackson
• Vandelle Dianne Jackson, PHARMD
• Vera Lorraine Jackson
• Waynyell Jackson, LCSW-C
• Carla Jacob
• Fadi Paul Jacob
• Priyanka Jacob
• Andrea Jacobs
• Ashley Jacobs

• Professional Counselor in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.