Dominique Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34009080A Issued in IN

Practice address

2106 Morthland Dr Unit 1086
Valparaiso, IN 46383-5914

Phone

(219) 508-5646

NPI assigned

Dec 30, 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

Other identifiers 2

Other names 1

• Dominique Jackson Pittman Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dominique.jackson.p1@direct.northshorehealth.nextgenshare.com

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.

• Hamilton Center, Inc.

  • Community/Behavioral Health Agency
  • Terre Haute, IN
  • NPI 1205980901
  Medicare reassignment NPD
• Inspired Peace Counseling Services

  • Community/Behavioral Health Agency
  • Valparaiso, IN
  • NPI 1801487574

  Clinical

  NPD Authorized official
• Hamilton Center Inc.

  • Methadone Clinic
  • Vincennes, IN
  • NPI 1265053854
  NPD

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

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1891382339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3009 WINTER GARDEN DR",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463857140",
            "telephone_number": "219-613-7872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 MORTHLAND DR UNIT 1086",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463835914",
            "telephone_number": "219-508-5646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DOMINIQUE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-30",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34009080A",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IN",
            "license": "34009080A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.028567",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1891382339",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300049653",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "djp@inspiredpeace.org",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "3009 Winter Garden Dr",
            "city": "Valparaiso",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463857140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DOMINIQUE",
            "last_name": "JACKSON PITTMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Eric Izynski
• Ronald Edward Izynski I, DPM
• Colin N Jack, O.D.
• Jackie Gasparovic Corp.
• Nicole Toyi Jackson-Musenja, M.A.
• Jacobs Ladder
• La Tanya L Jahan Robbins
• Jain Counseling Services Inc.
• James Brown Psychiatry, LLC
• James E. Taylor Medical Professional Corporation

• Clinical Social Worker in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.