Shawan D Patterson Jackson, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PRC 369 Issued in DC

Practice address

1933 Montana Ave NE
Washington, DC 20002-1817

Phone

(202) 842-2016

NPI assigned

Jun 13, 2015

Last updated

Jul 17, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Progressive Life Center Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Washington, DC
  • NPI 1386786093
  NPD (past)
• Progressive Life Institute Inc

  • Psychologist
  • Washington, DC
  • NPI 1528426293
  NPD (past)

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

{
    "created_epoch": "1434153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437091200000",
    "number": "1629459888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 BLEAK HILL PL",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207748870",
            "telephone_number": "443-386-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 MONTANA AVE NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200021817",
            "telephone_number": "202-842-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHAWAN",
        "middle_name": "D PATTERSON",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-13",
        "last_updated": "2015-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "DC",
            "license": "PRC 369",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "DC",
            "license": "PRC369",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruthette Mary Jackson, CROP AND FIRST AIDE
• Shannon Daneigh Jackson
• Shantia Jackson
• Shari Aisha Jackson, LPTA
• Sharon Jackson
• Shawnee Jackson
• Shawnita Sharay Jackson
• Shirley Jackson
• Shontell Jackson, HHA
• Sonya Marie Jackson

• Mental Health Counselor in Washington, DC
• Providers in Washington, DC by specialty
• Mental Health Counselor in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; 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.