Angela Jackson, LISW-CP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

13959 Issued in SC

Practice address

1180 Columbia Ave Ste 101
Irmo, SC 29063-2890

Phone

(803) 575-0579

Fax

(803) 830-3873

NPI assigned

Nov 7, 2017

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

Other identifiers 1

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

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Inspired Wellness, LLC

  dba Angela S. Jackson

  • Clinical Social Worker
  • Irmo, SC
  • NPI 1528644713
  Medicare reassignment NPD Authorized official
• Lexington Richland Alcohol & Drug Abuse Council, Inc.

  dba Lradac

  • Addiction Medicine (Family Medicine) Physician
  • Columbia, SC
  • NPI 1437924438
  NPD (past)

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681430400000",
    "number": "1922511419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 COLUMBIA AVE STE 101",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632890",
            "telephone_number": "803-575-0579",
            "fax_number": "803-830-3873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 COLUMBIA AVE STE 101",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632890",
            "telephone_number": "803-575-0579",
            "fax_number": "803-830-3873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANGELA",
        "credential": "LISW-CP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-07",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "13959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SW1739",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Irmo Family Chiropractic, Inc
• Irmo Kids Dental LLC (Irmo Dentistry)
• Irmo Primary Eyecare LLC (Irmo Primary Eyecare)
• Everlena Isaac
• J&J Anesthesia, LLC
• Laurie Wilkie Jackson, MSP-CCC, SLP
• Lesa Marie Jackson, APRN
• Jakyve Consulting, LLC
• Jakyve Healthcare Consulting & Education
• Lesly Wilson James, PHD, OTR/L

• Clinical Social Worker in Irmo, SC
• Providers in Irmo, SC by specialty
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.