Elaine Jackson, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LC9062 Issued in MD

Practice address

325 Cherry St
Philadelphia, PA 19106-2061

Phone

(202) 780-5333

NPI assigned

Nov 2, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Elaine Smith Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Balanced Space Wellness LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Charlotte, NC
  • NPI 1801686209
  NPD Authorized official

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

{
    "created_epoch": "1478044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1700338142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 CHERRY ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191062061",
            "telephone_number": "202-780-5333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 CHERRY ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191062061",
            "telephone_number": "202-780-5333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ELAINE",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-02",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "DC",
            "license": "LGPC00898",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0701010327",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LGP7431",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC9062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELAINE",
            "last_name": "SMITH",
            "credential": "LCPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Crystal Rena Jackson, LPC
• Darryl Brett Jackson, M.D.
• Demeetra Jackson
• Donchelle Jackson
• Dvone Jackson, MD
• Elijah Jagger Jackson, LCSW
• Fatima Jackson
• Gabriella Jackson
• Gail M Jackson, MA
• Ikishia N Jackson, R.N

• Mental Health Counselor in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Mental Health Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.