Active NPI
Mary Gennifer Jackson, LCPC
- Professional Counselor
- Westminster, MD
National Provider Identifier
1649559410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LC0855
- Practice address
- 904-A Washington Road
Westminster, MD 21157 - Phone
- (410) 751-9205
- Fax
- (410) 751-6191
- NPI assigned
- Aug 11, 2011
- 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 | LC0855 | MD | Primary |
Addresses
Primary practice location
904-A Washington Road
Westminster, MD 21157
Mailing address
6 Park Center Court
Suite 103
Owings Mills, MD 21117
Phone (410) 356-3344
Other names 1
- Mary Jackson Clark
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC0855 | MD | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cynthia Voelz | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706486400000",
"number": "1649559410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 PARK CENTER COURT",
"address_2": "SUITE 103",
"city": "OWINGS MILLS",
"state": "MD",
"postal_code": "21117",
"telephone_number": "410-356-3344",
"fax_number": "410-356-4459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904-A WASHINGTON ROAD",
"city": "WESTMINSTER",
"state": "MD",
"postal_code": "21157",
"telephone_number": "410-751-9205",
"fax_number": "410-751-6191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARY",
"middle_name": "GENNIFER",
"name_prefix": "Ms.",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-11",
"last_updated": "2024-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LC0855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "CLARK",
"middle_name": "JACKSON",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Westminster, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.