Samantha Lachelle Jackson, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LC11555 Issued in MD

Practice address

4317 Harford Rd
Baltimore, MD 21214-3118

Phone

(443) 708-7510

Fax

(410) 275-0992

NPI assigned

Jul 3, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jacksons Jubilee LLC

  • Professional Counselor
  • Baltimore, MD
  • NPI 1588520563
  Medicare reassignment NPD Authorized official
• Helping Others Manage Emotions

  • Mental Health Counselor
  • Baltimore, MD
  • NPI 1245839265
  NPD (past)

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

{
    "created_epoch": "1562112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1609438225",
    "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": "410-275-0994",
            "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": "443-708-7510",
            "fax_number": "410-275-0992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SAMANTHA",
        "middle_name": "LACHELLE",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-03",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LGP9650",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC11555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210292700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Allison Jackson
• Rebecca Ann Jackson
• Rebecca Yvette Jackson, NP
• Rosa Jackson, LGSW
• Sadhana Jackson, MD
• Selah Jackson
• Shala Jackson
• Shamirah Natarsha Jackson, LMSW
• Shay Jackson
• Sheila J. Jackson, R.K.T., C.D.R.S.

• 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 Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.