Jackson Counseling Associates

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

JACKSON COUNSELING ASSOCIATES

Practice address

4130 Linden Ave Ste 250
Dayton, OH 45432-3048

Phone

(937) 681-9644

NPI assigned

Jun 14, 2019

Organization subpart

No

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

Authorized official

Name

Carroll S Jackson, MSW,LISW-SNPI 1184097842

Title

Owner

Phone

(937) 681-9644

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carroll S Jackson, L.I.S.W.

  • Clinical Social Worker
  • Dayton, OH
  • NPI 1184097842
  NPD (past) Authorized official

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

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560470400000",
    "number": "1740840545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6504 SEMMES LN",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454247117",
            "telephone_number": "937-681-9644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 LINDEN AVE STE 250",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454323048",
            "telephone_number": "937-681-9644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNSELING ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-14",
        "last_updated": "2019-06-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CARROLL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-681-9644",
        "authorized_official_credential": "MSW,LISW-S"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://carroll-jackson.clientsecure.me",
            "affiliation": "N",
            "endpointDescription": "secured webportal",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PHI",
            "address_1": "4130 Linden Ave Ste 250",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454323048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• J and M Adult Day Facilities Inc.
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• J&J Ohio Transportation LLC
• J&M Transit LLC
• Elvira R. Jaballas, MD
• Nicole Jackson Vicente, LMT
• Aaliyah Jackson
• Alexa Jackson
• Alexandria Jackson, RDN, LD
• Amanda Jackson

• Mental Health Clinic/Center (Including Community Mental Health Center) in Dayton, OH
• Providers in Dayton, OH by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; 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.