Active NPI
Letorrian Jackson, LLMSW
- Social Worker
- Southgate, MI
National Provider Identifier
1902314818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801103812
- Practice address
- 13101 Allen Rd
Southgate, MI 48195 - Phone
- (734) 785-7700
- NPI assigned
- Jan 12, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Social Worker | 104100000X | 6801103812 | MI | Primary |
Addresses
Primary practice location
13101 Allen Rd
Southgate, MI 48195
Mailing address
13101 Allen Rd
Southgate, MI 48195-2216
Phone (734) 785-7700
Other practice location 1
6700 Middlebelt Rd
Romulus, MI 48174-2039
Phone (734) 595-3640
Other practice location 2
13101 Allen Rd
Southgate, MI 48195
Phone (734) 785-7700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801103812 | MI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Guidance Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Southgate, MI
- NPI 1609947027
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550534400000",
"number": "1902314818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13101 ALLEN RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952216",
"telephone_number": "734-785-7700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13101 ALLEN RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "48195",
"telephone_number": "734-785-7700"
}
],
"practiceLocations": [
{
"address_1": "6700 Middlebelt Rd",
"address_purpose": "LOCATION",
"city": "Romulus",
"state": "MI",
"postal_code": "481742039",
"country_code": "US",
"telephone_number": "734-595-3640",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "13101 Allen Rd",
"address_purpose": "LOCATION",
"city": "Southgate",
"state": "MI",
"postal_code": "48195",
"country_code": "US",
"telephone_number": "734-785-7700",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "LETORRIAN",
"credential": "LLMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-12",
"last_updated": "2019-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801103812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.