Shanna Jackson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401013761 Issued in MI

Practice address

18007 Juliana Ave
Eastpointe, MI 48021-3205

Phone

(313) 544-3513

NPI assigned

Mar 23, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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 and National Provider Directory roles.

• The Source Counseling, Case Management and Consultation

  • Professional Counselor
  • Southfield, MI
  • NPI 1437640687
  NPD Authorized official
• Behavioral Health Specialists (de), P.a.

  • Neurology Physician
  • Sugar Land, TX
  • NPI 1831619410

  Professional

  NPD (past)

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

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1922492594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18007 JULIANA AVE",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480213205",
            "telephone_number": "313-544-3513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18007 JULIANA AVE",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480213205",
            "telephone_number": "313-544-3513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "38271 Mound Rd Bldg B",
            "address_purpose": "LOCATION",
            "city": "Sterling Heights",
            "state": "MI",
            "postal_code": "483103401",
            "country_code": "US",
            "telephone_number": "586-477-2054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHANNA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-23",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "MI",
            "license": "6401013761",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401013761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malik Omarion Jackson-Smith
• Bryanna Jackson
• Charlene Rene Jackson
• Dawn Maureen Jackson, LMSW
• Natasha Jackson
• Tracey Francine Jackson
• Yolanda James-Thurman, MSW
• Mary Janke
• Johnnisha Jenkins
• Scott Jenner

• Professional Counselor in Eastpointe, MI
• Providers in Eastpointe, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; 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.