Active NPI
Michael Jackson, M.A., N.C.C,
- Mental Health Counselor
- Newark, DE
National Provider Identifier
1639625833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- AC-0000107
- Practice address
- 128 Mute Swan Place
Newark, DE 19711 - Phone
- (786) 333-8982
- NPI assigned
- Aug 28, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | AC-0000107 | DE | Primary |
Addresses
Primary practice location
128 Mute Swan Place
Newark, DE 19711
Mailing address
2415 E Eric Dr
Wilmington, DE 19808-4206
Phone (786) 333-8982
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC-0000107 | DE | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472342400000",
"number": "1639625833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2415 E ERIC DR",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198084206",
"telephone_number": "786-333-8982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "128 MUTE SWAN PLACE",
"city": "NEWARK",
"state": "DE",
"postal_code": "19711",
"telephone_number": "786-333-8982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHAEL",
"credential": "M.A., N.C.C,",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-28",
"last_updated": "2016-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "DE",
"license": "AC-0000107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.