Lacrezia Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904010568 Issued in VA

Practice address

7025 Harbour View Blvd Ste 119
Suffolk, VA 23435-2762

Phone

(757) 966-2805

Fax

(757) 673-6135

NPI assigned

Jul 31, 2018

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

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Western Tidewater Community Mental

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Suffolk, VA
  • NPI 1689615296
  NPD

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532995200000",
    "number": "1700364908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7025 HARBOUR VIEW BLVD STE 119",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234352762",
            "telephone_number": "757-966-2805",
            "fax_number": "757-673-6135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7025 HARBOUR VIEW BLVD STE 119",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234352762",
            "telephone_number": "757-966-2805",
            "fax_number": "757-673-6135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LACREZIA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-31",
        "last_updated": "2018-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904010568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anaiya Jackson
• Ayumi Jackson
• Christina Michelle Jackson, DO
• Jerome Christopher Jackson
• Julian Myles Jackson
• Pharnethia Goodman Jackson, NP-C
• Vanessa Jackson
• William G Jackson, MD
• Malik Jaggard
• Muna A Jama, MD

• Clinical Social Worker in Suffolk, VA
• Providers in Suffolk, 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 31, 2018; 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.