Active NPI
Kimberly Ann Jackson-Luzader, LPC, NCC
- Professional Counselor
- Raleigh, NC
National Provider Identifier
1780918912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 8795
- Practice address
- 6716 Six Forks Rd
Raleigh, NC 27615-6575 - Phone
- (919) 996-1276
- NPI assigned
- Sep 21, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178006189 | IL | |
| Professional Counselor | 101YP2500X | 8795 | NC | Primary |
Addresses
Primary practice location
6716 Six Forks Rd
Raleigh, NC 27615-6575
Mailing address
PO Box 590
Raleigh, NC 27602-0590
Phone (919) 996-1276
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 |
|---|---|---|---|
| 178006189 | IL | MD | Professional Counselor |
| 8795 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487548800000",
"number": "1780918912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 590",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276020590",
"telephone_number": "919-996-1276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6716 SIX FORKS RD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276156575",
"telephone_number": "919-996-1276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON-LUZADER",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"credential": "LPC, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-21",
"last_updated": "2017-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178006189",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "8795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.