Fredericka Arlene Jackson, PH.D. CAC II

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

License

6301008884 Issued in MI

Practice address

38815 Dequindre Rd
Troy, MI 48083-5769

Phone

(248) 250-7323

NPI assigned

Nov 10, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Henry Ford Macomb Hospital Corporation

  • Psychologist
  • Clinton Township, MI
  • NPI 1194869107
  NPD (past)

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1922089531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43220 FOUNTAIN DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483132394",
            "telephone_number": "586-532-9948",
            "fax_number": "586-263-2762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38815 DEQUINDRE RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480835769",
            "telephone_number": "248-250-7323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "FREDERICKA",
        "middle_name": "ARLENE",
        "name_prefix": "Dr.",
        "credential": "PH.D. CAC II",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-10",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "6301008884",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301008884",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milad Jabow
• Jacastillano PLLC
• Mercedese Jack
• Denise Jackson
• Erica L Jackson
• Julia Jackson, FNP-BC
• Kenya Jackson
• Marcus Dangelo Jackson
• Natalie Jeanee Jackson
• Nicole Jackson

• Addiction (Substance Use Disorder) Psychologist in Troy, MI
• Providers in Troy, MI by specialty
• Addiction (Substance Use Disorder) Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.