Kyliah Laneice Jackson, LISW-CP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

29403 Issued in MN

Practice address

1 Rice Pointe CT
Columbia, SC 29203-9025

Phone

(708) 675-9061

NPI assigned

May 8, 2018

Reactivated

Dec 19, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other names 1

• Kyliah Laneice Thompson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1871082438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 RICE POINTE CT",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039025",
            "telephone_number": "708-675-9061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RICE POINTE CT",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292039025",
            "telephone_number": "708-675-9061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8505 183rd St Ste D",
            "address_purpose": "LOCATION",
            "city": "Tinley Park",
            "state": "IL",
            "postal_code": "604879353",
            "country_code": "US",
            "telephone_number": "708-864-2990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KYLIAH",
        "middle_name": "LANEICE",
        "credential": "LISW-CP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-08",
        "last_updated": "2025-02-24",
        "certification_date": "2025-01-31",
        "deactivation_date": "2024-12-09",
        "reactivation_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "29403",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "29403",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "SC",
            "license": "17505",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "17505",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLIAH",
            "last_name": "THOMPSON",
            "middle_name": "LANEICE",
            "credential": "LICSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jordan D Jackson, PHARMD
• Juanetta Jackson, APRN
• Karen Jackson, APRN
• Kathy Melton Jackson, R.N.
• Kayla Mackenzie Jackson, PTA
• Laquanda Jackson
• Larry Randolph Jackson, REGISTERED NURSE
• Latonya Demetria Jackson, CAC II
• Latoya S Jackson, PTA
• Laura B Jackson, MD

• Clinical Social Worker in Columbia, SC
• Providers in Columbia, SC by specialty
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; 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.