Active NPI
Adrienne McGahee Jackson, LPC
- Professional Counselor
- Marietta, GA
National Provider Identifier
1679609036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 04539
- Practice address
- 122 Cherry St.
Marietta, GA 30060 - Phone
- (770) 427-7441
- Fax
- (770) 422-2302
- NPI assigned
- Feb 27, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Psychologist | 103T00000X | 004539 | GA | |
| Professional Counselor | 101YP2500X | 04539 | GA | Primary |
Addresses
Primary practice location
122 Cherry St.
Marietta, GA 30060
Mailing address
122 Cherry St.
Marietta, GA 30060
Phone (770) 427-7441
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 214383008A | Medicaid | GA |
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 |
|---|---|---|---|
| 04539 | GA | MD | Professional Counselor |
| 004539 | GA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268006400000",
"number": "1679609036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 CHERRY ST.",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30060",
"telephone_number": "770-427-7441",
"fax_number": "770-422-2302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 CHERRY ST.",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30060",
"telephone_number": "770-427-7441",
"fax_number": "770-422-2302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ADRIENNE",
"middle_name": "MCGAHEE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-27",
"last_updated": "2010-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "004539",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "04539",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "214383008A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.