Patricia Katherine Jackson, LCMHC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

13613 Issued in NC

Practice address

2311 W Cone Blvd Ste 234
Greensboro, NC 27408-4062

Phone

(336) 585-7012

NPI assigned

Apr 18, 2018

Last updated

Oct 19, 2021By the provider in NPPES

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

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.

• Restoration Place Ministries, Inc.

  dba Restoration Place Counseling

  • Professional Counselor
  • Greensboro, NC
  • NPI 1235528464
  NPD (past)

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

{
    "created_epoch": "1524009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1629565361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 CAROLINA ST STE 114",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011090",
            "telephone_number": "704-340-1765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 W CONE BLVD STE 234",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274084062",
            "telephone_number": "336-585-7012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PATRICIA",
        "middle_name": "KATHERINE",
        "name_prefix": "Miss",
        "credential": "LCMHC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-18",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "13613",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A13613",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Hamilton Jackson, M.A. LPC
• Kyle E. Jackson, MD
• Lily Diana Jackson, RN
• Michelle Jackson, FNP-BC
• Miya Jackson
• Vera Mae Jackson
• Sera L Jacob, MD
• Anna Victoria Jacobs, PA
• Bret Charles Jacobs, D.O.
• Brianna Kaitlin Jacobs

• Mental Health Counselor in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; 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.