Jackson Lufuakiadi Nsilulu, P.C, AND L.I.C.D.C.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0007453 Issued in OH

Practice address

313 Verdon PL
Trotwood, OH 45426-2754

Phone

(937) 286-3886

NPI assigned

Aug 16, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313452800000",
    "number": "1750660106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 VERDON PLACE",
            "city": "TROTWOOD",
            "state": "OH",
            "postal_code": "45426",
            "telephone_number": "937-286-3886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 VERDON PL",
            "city": "TROTWOOD",
            "state": "OH",
            "postal_code": "454262754",
            "telephone_number": "937-286-3886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NSILULU",
        "first_name": "JACKSON",
        "middle_name": "LUFUAKIADI",
        "name_prefix": "Mr.",
        "credential": "P.C, AND  L.I.C.D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-16",
        "last_updated": "2011-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "0007453",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "991504",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "0007453",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "0007453",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "OH",
            "license": "0007453",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Trotwood, OH
• Providers in Trotwood, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.