Mary P Jackson, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P014930 Issued in NC

Practice address

4035 University Pkwy Ste 101
Winston Salem, NC 27106-3275

Phone

(336) 663-2751

NPI assigned

Jul 13, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1922626191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2648 RANDELMAN RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274065108",
            "telephone_number": "336-587-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 UNIVERSITY PKWY STE 101",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063275",
            "telephone_number": "336-663-2751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "middle_name": "P",
        "credential": "LCSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-13",
        "last_updated": "2020-10-02",
        "certification_date": "2020-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P014930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Marie Jackson, MD
• Jimmy Demario Jackson, OTRL
• Kasey Jackson
• Kerrington Jackson
• Linda L. Jackson, MAED., LPC, CGP, NCC
• Megan Ezelle Jackson, CRNA
• Richard Dewitt Jackson II, M.D.
• Shermeca Kyhana Jackson, PT
• Staci Tate Jackson, SLP
• Teresa B. Jackson, RPH.

• Clinical Social Worker in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; 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.