Carolyn Denise Jackson, LCSW, LCAS-A

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C011298 Issued in NC

Practice address

3205 Randall Pkwy Ste 121
Wilmington, NC 28403

Phone

(910) 520-6083

NPI assigned

Aug 7, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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 1

Specialty

Clinical Social Worker

Education

Brody School of Medicine at East Carolina University, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carolynjackson@carolyn-jackson-dba-tirz.direct.kno2fy.com

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.

• Tirzah Wellness Center, PLLC

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1588156137

  Clinical

  NPD Authorized official
• Community Support Agency, LLC

  • Community/Behavioral Health Agency
  • Delco, NC
  • NPI 1447393020
  NPD (past)

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

{
    "created_epoch": "1249603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556928000000",
    "number": "1689805657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 RANDALL PKWY STE 121",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284032567",
            "telephone_number": "910-520-6083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 RANDALL PKWY STE 121",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28403",
            "telephone_number": "910-520-6083"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44 Dream Ave",
            "address_purpose": "LOCATION",
            "city": "Delco",
            "state": "NC",
            "postal_code": "284368700",
            "country_code": "US",
            "telephone_number": "910-655-0698",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "610 Varsity Dr",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284038444",
            "country_code": "US",
            "telephone_number": "910-520-6083",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1213 Culbreth Dr",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284053639",
            "country_code": "US",
            "telephone_number": "910-520-6083",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3205 Randall Pkwy Ste 121",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "28403",
            "country_code": "US",
            "telephone_number": "910-520-6083 x91052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CAROLYN",
        "middle_name": "DENISE",
        "credential": "LCSW, LCAS-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-07",
        "last_updated": "2019-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "22913",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C011298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Eye Associates, OD PA
• Jackson Eye Associates, OD PA
• Jackson Eye Associates, OD, PA
• Allison Elizabeth Jackson, LCSWA
• Brianna Holton Jackson, LCSW
• Cory Daniel Jackson
• Eric Michael Jackson, M.D.
• Jennifer Ann Jackson, LCSWA
• Jerry Edwin Jackson Jr., LPC
• Joann Kate Jackson, PAC

• Clinical Social Worker in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.