Jacqueline Nicole Jackson, BSPM/BA/MSFP
Individual provider Active NPI Mental Health Counselor · Guyton, GA
NPI 1629935978 · NPPES record last updated Jan 8, 2026
Key facts
- NPI
- 1629935978
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 174 Scholar Rd
Guyton, GA 31312-6240 - Phone
- (912) 231-7061
- NPI assigned
- Jan 8, 2026
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr Crystal Malloy PHD LPC Mac Ceap LLC | Mental Health | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
174 Scholar Rd
Guyton, GA 31312-6240
Mailing address
174 Scholar Rd
Guyton, GA 31312-6240
Phone (912) 231-7061
Other providers in Guyton, GA
- Joanna Hicks
- Laura Moreland Hodges
- Lauren Horton
- India I'Dalis Hudson
- Juanita Nichole Hudson
- Roland Robert Jackson Jr.
- Amanda Johnson-Kennehan
- Dan Bernard Johnson Jr.
- Shannon Bragg Jones
- Key 4 Changes LLC
All providers in Guyton, GA · Mental Health Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.