Melissa M Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C10824 Issued in MS

Practice address

2715 Bullis Ave
Gulfport, MS 39501-5233

Phone

(228) 697-3953

NPI assigned

Dec 27, 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

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Premier Professional Counseling Services, LLC

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1750878781
  Medicare reassignment NPD
• Kimila Deflanders LCSW LLC

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1588217699
  NPD (past)

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

{
    "created_epoch": "1703635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1851160253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 BULLIS AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395015233",
            "telephone_number": "228-697-3953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 BULLIS AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395015233",
            "telephone_number": "228-697-3953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELISSA",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-27",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C10824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Dean Jackson, R.PH.
• Janice L. Jackson
• Jennifer Jackson, NP
• Linda Natasha Rene Jackson, LPC
• Lucia Jackson, LOT, CHT
• Monifa Chyenn Jackson, HNT/SNT
• Shavoka L Jackson
• Shaynell Jackson
• Timothy D Jackson, MD, SA-C
• Jackson's Discount Pharmacy, Inc.

• Clinical Social Worker in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.