Lavila D Jackson

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

7090 Samuel Morse Dr Ste 100
Columbia, MD 21046-3444

Phone

(443) 852-7036

NPI assigned

Jun 23, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1639855836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6246 HEATHER GLEN WAY",
            "city": "CLARKSVILLE",
            "state": "MD",
            "postal_code": "210291175",
            "telephone_number": "443-852-7036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7090 SAMUEL MORSE DR STE 100",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210463444",
            "telephone_number": "443-852-7036"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2811 Pennsylvania Ave SE",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200203865",
            "country_code": "US",
            "telephone_number": "202-894-6811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LAVILA",
        "middle_name": "D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ericka Alyce Jackson, RN
• Jia Jackson
• Jodeci Jackson
• Joshue Jackson
• Kiana Jackson
• Lena Jackson
• Malayiah Jackson
• Mariah Jackson
• Marquan Jackson, LLMSW
• Mercy Preethi Jackson, M.D.

• Community/Behavioral Health Agency in Columbia, MD
• Providers in Columbia, MD by specialty
• Community/Behavioral Health Agency in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.