Rebecca Jo Jackson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

17497 Issued in NC

Practice address

25 Springdale Dr
Travelers Rest, SC 29690-2159

Phone

(864) 610-0658

NPI assigned

Jul 7, 2008

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

Other names 1

• Rebecca Jo Jackson Professional name

Medicare fee-for-service enrollment

Enrolled in SC

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stilwell Counseling LLC

  • Professional Counselor
  • Travelers Rest, SC
  • NPI 1770215519
  NPD Authorized official
• Itrust Wellness Group

  • Psychiatry Physician
  • Greenville, SC
  • NPI 1629517222
  Medicare reassignment
• Stilwell Counseling LLC

  • Professional Counselor
  • Travelers Rest, SC
  • NPI 1750160586
  Authorized official Same address or phone

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

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1902069214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 504",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296900504",
            "telephone_number": "864-610-0658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 SPRINGDALE DR",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296902159",
            "telephone_number": "864-610-0658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "REBECCA",
        "middle_name": "JO",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-07",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "8204",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "17497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "JACKSON",
            "middle_name": "JO",
            "credential": "LCMHC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Portia Goode Jackson
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• Jon Michael Julian, DDS
• Kathleen Diane Juliano, OD
• Richard Kania

• Professional Counselor in Travelers Rest, SC
• Providers in Travelers Rest, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; 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.