Charmayne Latriece Jackson, MS, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH22183 Issued in FL

Practice address

2601 NW 23Rd Blvd Apt 243
Gainesville, FL 32605-5958

Phone

(317) 698-2713

NPI assigned

Feb 14, 2019

Sex

Female

Sole proprietor

No

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)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1922564012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 NW 23RD BLVD APT B20",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326052926",
            "telephone_number": "317-698-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 NW 23RD BLVD APT 243",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326055958",
            "telephone_number": "317-698-2713"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4300 SW 13th St",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326084006",
            "country_code": "US",
            "telephone_number": "352-374-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHARMAYNE",
        "middle_name": "LATRIECE",
        "credential": "MS, LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-14",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH22183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Prestemon Jackson, BCBA
• Ashley Carol Jackson
• Brittany Nichole Jackson
• Cailyx Jackson
• Chandra Jackson
• Cynthia Jackson
• Donald E Jackson Jr., MD
• Dorothy Mae Jackson
• Jabreana Jackson
• Jacqueline Kay Jackson, M.D.

• Mental Health Counselor in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.