NPIMap

Individual provider Active NPI

Tonjanika Jackson, PHD

  • Professional Counselor
  • Augusta, GA
National Provider Identifier
1821495961
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC006878 Issued in GA
Practice address
3633 Wheeler Rd Ste 100
Augusta, GA 30909-6550
Phone
(706) 364-0252
Fax
(706) 364-0269
NPI assigned
Dec 3, 2014
Last updated
Nov 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CPD0044 GA
Professional Counselor 101YP2500X LPC006878 GA Primary

Addresses

Primary practice location

3633 Wheeler Rd Ste 100
Augusta, GA 30909-6550

Mailing address

3633 Wheeler Rd Ste 100
Augusta, GA 30909-6550
Phone (706) 364-0252

Other identifiers 1

IdentifierTypeStateIssuer
1518487529OtherGANPI

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
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
CPD0044GAMDAddiction (Substance Use Disorder) Counselor
LPC006878GAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Teladoc Health Medical Group, P.a. Professional Current Accepting new patients
Jacksons Counseling Services LLC Addiction (Substance Use Disorder) Current Accepting new patients
Jacksons Counseling Services Professional Current Accepting new patients

Locations

3633 Wheeler Rd
Ste 100
Augusta, GA 30909
Phone (706) 364-0252

Interoperability endpoints

  • Direct secure messaging: tonjanikajackson@tdh.allscriptsdirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1821495961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3633 WHEELER RD STE 100",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096550",
            "telephone_number": "706-364-0252",
            "fax_number": "706-364-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3633 WHEELER RD STE 100",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096550",
            "telephone_number": "706-364-0252",
            "fax_number": "706-364-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TONJANIKA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-03",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "CPD0044",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC006878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1518487529",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; 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.