Bethena M Jackson, CSAC, LCAS-A

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

2421 Issued in NC

Practice address

2604 Carver St
Suite C
Durham, NC 27705-2796

Phone

(919) 682-4771

Fax

(919) 683-2641

NPI assigned

Dec 15, 2012

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1355529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355529600000",
    "number": "1881930006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 PEAR TREE LN",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277036280",
            "telephone_number": "919-633-8360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 CARVER ST",
            "address_2": "SUITE C",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277052796",
            "telephone_number": "919-682-4771",
            "fax_number": "919-683-2641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BETHENA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "CSAC, LCAS-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-15",
        "last_updated": "2012-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "2421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamillah A. Jackson Kelly, MS/EDS, NCC, LCMHCS
• Jackson Odondi
• Akua Jackson, PHD
• Alexandra Megan Jackson, CPNP
• Ashton Jackson, RDN
• Brooke A Jackson, MD
• Carrie Ann Jackson, M.ED
• Christy Jackson, RD, LDN
• Delqwan Rashawn Jackson, MSW, LCSWA
• Diamond Mone Jackson, PT, DPT

• Addiction (Substance Use Disorder) Counselor in Durham, NC
• Providers in Durham, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.