Active NPI
Gracie Jackson
- Behavior Technician
- Centreville, VA
National Provider Identifier
1649084351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB1106900
- Practice address
- 5830 Stone Ridge Dr
Centreville, VA 20120-2887 - Phone
- (718) 215-5311
- Fax
- (718) 865-5165
- NPI assigned
- Feb 3, 2025
- Last updated
- Feb 3, 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | BACB1106900 | VA | Primary |
Addresses
Primary practice location
5830 Stone Ridge Dr
Centreville, VA 20120-2887
Mailing address
13800 Coppermine Rd
Herndon, VA 20171-6163
Phone (718) 215-5311
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 |
|---|---|---|---|
| BACB1106900 | VA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738540800000",
"number": "1649084351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13800 COPPERMINE RD",
"city": "HERNDON",
"state": "VA",
"postal_code": "201716163",
"telephone_number": "718-215-5311",
"fax_number": "718-865-5165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5830 STONE RIDGE DR",
"city": "CENTREVILLE",
"state": "VA",
"postal_code": "201202887",
"telephone_number": "718-215-5311",
"fax_number": "718-865-5165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "GRACIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-03",
"last_updated": "2025-02-03",
"certification_date": "2025-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "VA",
"license": "BACB1106900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centreville, VA
- George B. Iskander, MD
- Asma Islam, M.D.
- Claudio Enrique Iwamoto, D.D.S., M.S.
- J and R Advisers LLC (Creative Health Solutions)
- Jackson Clinics Limited Partnership
- Margaret Kay Jackson, OTR/L
- Noni Tene Jackson I
- Laura Elizabeth Jacobs, MS CCC-SLP
- Jae M Chong DMD PC (Centreville Dental Design)
- Holly B Jahshan, DPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.