Stefanie Charisse Jackson, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

0717001609 Issued in VA

Practice address

260 Peachtree St NW Ste 2200
Atlanta, GA 30303-1292

Phone

(301) 392-7779

NPI assigned

Apr 6, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Divine Mind Therapeutics LLC

  • Mental Health Counselor
  • Richmond, VA
  • NPI 1407584204
  NPD

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1891324430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9846 LORI RD STE 201",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238326695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 PEACHTREE ST NW STE 2200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303031292",
            "telephone_number": "301-392-7779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEFANIE",
        "middle_name": "CHARISSE",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-06",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "VA",
            "license": "0717001609",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT001862",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "TPMF1187",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reginald Roberts Jackson, M.D.
• Roger Lee Jackson II
• Ryan Theron Jackson
• Samuel Lee Jackson
• Shamika Jackson, RN
• Stephane Lea Jackson, LMT, CCT
• Sunny Michele Jackson
• Taneisha Chree Jackson
• Tanjela M Jackson, MD
• Tanya Tamara Jackson, APRN

• Marriage & Family Therapist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Marriage & Family Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.