Simajah Dominique Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904013854 Issued in VA

Practice address

4410 Shirley Gate Rd
Fairfax, VA 22030-5518

Phone

(703) 205-9452

Fax

(703) 653-1389

NPI assigned

Jul 6, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657065600000",
    "number": "1699408682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14166 CUDDY LOOP APT 304",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221935995",
            "telephone_number": "254-423-8065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 SHIRLEY GATE RD",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305518",
            "telephone_number": "703-205-9452",
            "fax_number": "703-653-1389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SIMAJAH",
        "middle_name": "DOMINIQUE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-06",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904013854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Marie Jackson
• Kenneth William Jackson, MD
• Keshonna Jackson
• Linda Jackson
• Megan Nicole Jackson
• Jacob T Joseph MD PC
• Allyson Jacobi
• David Alan Jacobs, LPC
• Deana Jacobs, LCPC, CCTP
• Nicole Jacobs, PT, DPT

• Clinical Social Worker in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.