Carmella Jackson, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

PC007622 Issued in PA

Practice address

261 Old York Rd Ste 709
Jenkintown, PA 19046-3728

Phone

(215) 690-1004

Fax

(267) 907-1120

NPI assigned

Jun 29, 2015

Last updated

Nov 14, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellus LLC

  • Community/Behavioral Health Agency
  • Jenkintown, PA
  • NPI 1538720057
  NPD Authorized official

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1902288764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7973 THOURON AVE",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191502520",
            "telephone_number": "267-307-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 OLD YORK RD STE 709",
            "city": "JENKINTOWN",
            "state": "PA",
            "postal_code": "190463728",
            "telephone_number": "215-690-1004",
            "fax_number": "267-907-1120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7973 Thouron Ave",
            "address_2": "2nd Floor",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191502520",
            "country_code": "US",
            "telephone_number": "215-690-1004",
            "fax_number": "267-907-1120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CARMELLA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-29",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "PA",
            "license": "8062",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "PC007622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Interface Psych Services, Inc
• International Medical Supplies LLC
• It Takes a Breath, LLC
• Bailey Ivanoski, CRNP
• Tammy Lynn Jabarin, MSW,MT
• Monee Jackson
• Carl J Jacobsen Sr., CERTIFIED OPTICIAN A
• Mindy Jacobson Levy, MCAT, ATR-BC, LPC
• Lynn Calvin Jaeger, M.S.
• JDM Partners LLC (Jenkintown Dental Medicine)

• Mental Health Counselor in Jenkintown, PA
• Providers in Jenkintown, PA by specialty
• Mental Health Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.