Active NPI
Keisha Jackson, LCPC
- Mental Health Counselor
- Camp Springs, MD
National Provider Identifier
1851869697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LC11445
- Practice address
- 5801 Allentown Rd Ste 310
Camp Springs, MD 20746-4564 - Phone
- (240) 392-2876
- NPI assigned
- Nov 9, 2018
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LGP8380 | MD | |
| Mental Health Counselor | 101YM0800X | LC11445 | MD | Primary |
Addresses
Primary practice location
5801 Allentown Rd Ste 310
Camp Springs, MD 20746-4564
Mailing address
12301 Welford Manor Dr
Upper Marlboro, MD 20772-6045
Phone (202) 486-2152
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD, DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2016
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Pittsburgh, PA 15251
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC11445 | MD | MD | Mental Health Counselor |
| LGP8380 | MD | MD | Mental Health Counselor |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648425600000",
"number": "1851869697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12301 WELFORD MANOR DR",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207726045",
"telephone_number": "202-486-2152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5801 ALLENTOWN RD STE 310",
"city": "CAMP SPRINGS",
"state": "MD",
"postal_code": "207464564",
"telephone_number": "240-392-2876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KEISHA",
"name_prefix": "Mrs.",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-09",
"last_updated": "2022-03-28",
"certification_date": "2022-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "MD",
"license": "LGP8380",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MD",
"license": "LC11445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camp Springs, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.