Ebone Jackson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

SW139545 Issued in PA

Practice address

4755 Linglestown Rd Ste 206
Harrisburg, PA 17112-8547

Phone

(717) 400-1871

Fax

(717) 814-5260

NPI assigned

Apr 4, 2023

Sex

Female

Sole proprietor

Yes

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)

Not 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.

• Purposefully Soaring Counseling Services LLC

  • Social Worker
  • Harrisburg, PA
  • NPI 1386298404
  NPD
• Purposefully Soaring Counseling Services LLC

  • Professional Counselor
  • Harrisburg, PA
  • NPI 1629549928
  NPD

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

{
    "created_epoch": "1680566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1740985209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4755 LINGLESTOWN RD STE 206",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171128547",
            "telephone_number": "717-400-1871",
            "fax_number": "717-814-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 LINGLESTOWN RD STE 206",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171128547",
            "telephone_number": "717-400-1871",
            "fax_number": "717-814-5260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EBONE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-04",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "SW139545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parul Krishnamurthy Iyer, MD
• Robert Izzo, PHD
• J&S Transportation Solutions LLC
• Katja Jablonski
• Alexis Jackson, PHARMD.
• Joshua Jackson, MD
• Kiera D Jackson
• Maria Jackson, LSW
• Shadear Jackson
• Stephen A Jackson, LSW

• Mental Health Counselor in Harrisburg, PA
• Providers in Harrisburg, 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 4, 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.