Antionette Marie Jackson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

110 Melaleuca Dr
Crawfordville, FL 32327-4963

Phone

(850) 617-9167

NPI assigned

Mar 1, 2021

Last updated

Mar 1, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in GA, TX, FL3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  GA, TX

  Medicare reassignment NPD
• Therapeutic Touch

  • Mental Health Counselor
  • Midway, FL
  • NPI 1427764422
  NPD Authorized official

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

{
    "created_epoch": "1614556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1649864885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N CHARLES WILLIS DR",
            "city": "MIDWAY",
            "state": "FL",
            "postal_code": "323434293",
            "telephone_number": "850-694-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MELALEUCA DR",
            "city": "CRAWFORDVILLE",
            "state": "FL",
            "postal_code": "323274963",
            "telephone_number": "850-617-9167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANTIONETTE",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-01",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denna Hunter, FNP-BC
• Iamceo Enterprise LLC. (Care About You)
• Inside the Cup LLC
• Lenedra Isaac, MSW
• Dana Marie Ivester, ARNP
• Lauren Jacobs, M. ED, CCC-SLP
• James a Stephens OD & Associates PA
• Jesse Mae Jenkins
• Jesscaring Companion Care, LLC (Jesscaring Home Care & Support Services)
• Sabrina Deanne Joiner, M.S.W.

• Mental Health Counselor in Crawfordville, FL
• Providers in Crawfordville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.