Active NPI
Nashota Lynn Jackson, LCPC, NCC
- Professional Counselor
- Annapolis, MD
National Provider Identifier
1639656200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LC10411
- Practice address
- 611 Ridgely Ave
Annapolis, MD 21401-1069 - Phone
- (410) 803-3318
- NPI assigned
- Jul 25, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | LC10411 | MD | Primary |
Addresses
Primary practice location
611 Ridgely Ave
Annapolis, MD 21401-1069
Mailing address
1121 Crestview Dr
Annapolis, MD 21409-4803
Other practice location 1
7310 Ritchie Hwy Ste 1009
Glen Burnie, MD 21061-3398
Phone (239) 537-6684
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC10411 | MD | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Mental Health | Current | Accepting new patients |
Interoperability endpoints
- nashotajackson@tdh.allscriptsdirect.net
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Lewisville, TX
- NPI 1245403567
Mental Health
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589414400000",
"number": "1639656200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1121 CRESTVIEW DR",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214094803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 RIDGELY AVE",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214011069",
"telephone_number": "410-803-3318"
}
],
"practiceLocations": [
{
"address_1": "7310 Ritchie Hwy Ste 1009",
"address_purpose": "LOCATION",
"city": "Glen Burnie",
"state": "MD",
"postal_code": "210613398",
"country_code": "US",
"telephone_number": "239-537-6684",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "NASHOTA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "LCPC, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-25",
"last_updated": "2020-05-14",
"certification_date": "2020-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LC10411",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annapolis, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.