Sandra Lynne Jackson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC012399 Issued in GA

Practice address

121 Jackson St
Newnan, GA 30263-1572

Phone

(770) 251-5873

Fax

(770) 304-2201

NPI assigned

Nov 16, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lighthouse Counseling PCGroup PAC ID 3577551738, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Lighthouse Counseling PC

  • Professional Counselor
  • Newnan, GA
  • NPI 1205961232
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1637020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637020800000",
    "number": "1881350551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 JACKSON ST",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302631572",
            "telephone_number": "770-251-5873",
            "fax_number": "770-304-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 JACKSON ST",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302631572",
            "telephone_number": "770-251-5873",
            "fax_number": "770-304-2201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44058 W US Highway 50",
            "address_purpose": "LOCATION",
            "city": "Canon City",
            "state": "CO",
            "postal_code": "812129743",
            "country_code": "US",
            "telephone_number": "720-635-0916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SANDRA",
        "middle_name": "LYNNE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-16",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC0012685",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC012399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Henry Jackson, DMD
• Lewis W. Jackson, M.D.
• Malasia Jackson, RBT
• Mallory Charlene Jackson
• Melvin Jackson, NP
• Willandria S Jackson
• Richard Lee Jacobs II, MD
• Melissa Lynn Jacobson
• Stephen William Jacon
• Linda Jah-Anayas

• Professional Counselor in Newnan, GA
• Providers in Newnan, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; 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.

Verify at the official NPI Registry.