Active NPI
Courtney Kelly Jackson
- Professional Counselor
- Charlotte, NC
National Provider Identifier
1649060765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 7401 Carmel Executive Park Dr Ste 210
Charlotte, NC 28226-0406 - Phone
- (704) 752-8414
- Fax
- (704) 544-1109
- NPI assigned
- May 12, 2025
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | Primary |
Addresses
Primary practice location
7401 Carmel Executive Park Dr Ste 210
Charlotte, NC 28226-0406
Mailing address
7401 Carmel Executive Park Dr Ste 210
Charlotte, NC 28226-0406
Phone (704) 752-8414
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolinas Counseling Group of Charlotte, Inc. | Professional | Past | Accepting new patients |
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.
-
- Marriage & Family Therapist
- Charlotte, NC
- NPI 1558335679
Professional
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781481600000",
"number": "1649060765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7401 CARMEL EXECUTIVE PARK DR STE 210",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282260406",
"telephone_number": "704-752-8414",
"fax_number": "704-544-1109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7401 CARMEL EXECUTIVE PARK DR STE 210",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282260406",
"telephone_number": "704-752-8414",
"fax_number": "704-544-1109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "COURTNEY",
"middle_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-12",
"last_updated": "2026-06-15",
"certification_date": "2026-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.