Active NPI
Michele Denise Jackson, RI-J0808181554
- Addiction (Substance Use Disorder) Counselor
- Oakland, CA
National Provider Identifier
1740411636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- RI-J808181554
- Practice address
- 10700 Macarthur Blvd
Ste 12
Oakland, CA 94605-5298 - Phone
- (510) 568-2432
- Fax
- (510) 568-3912
- NPI assigned
- Jul 27, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | RI-J808181554 | CA | Primary |
Addresses
Primary practice location
10700 Macarthur Blvd
Ste 12
Oakland, CA 94605-5298
Mailing address
10700 Macarthur Blvd
Ste 12
Oakland, CA 94605-5298
Phone (510) 568-2432
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 941702064 | Other | CA | ALCOHOL AND OTHER DRUG |
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 |
|---|---|---|---|
| RI-J808181554 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bi-Bett | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Case Management Agency
- Oakland, CA
- NPI 1669677803
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248652800000",
"number": "1740411636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10700 MACARTHUR BLVD",
"address_2": "STE 12",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946055298",
"telephone_number": "510-568-2432",
"fax_number": "510-568-3912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10700 MACARTHUR BLVD",
"address_2": "STE 12",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946055298",
"telephone_number": "510-568-2432",
"fax_number": "510-568-3912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHELE",
"middle_name": "DENISE",
"name_prefix": "Ms.",
"credential": "RI-J0808181554",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-27",
"last_updated": "2009-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "RI-J808181554",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALCOHOL AND OTHER DRUG",
"identifier": "941702064",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.