Jackson Professional Serv LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

JACKSON PROFESSIONAL SERV LLC

Doing business as

Valecia Jackson

Practice address

420 Pine Ridge Rd
Petersburg, VA 23805-1320

Phone

(804) 714-5998

NPI assigned

Oct 21, 2021

Organization subpart

No

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

Authorized official

Name

Antoinita C Stokes

Title

Consultant

Phone

(804) 613-0087

Specialties & licenses 5

Addresses

Other identifiers 5

Other names 1

• Valecia Jackson Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Valecia Jackson, CSAC

  • Addiction (Substance Use Disorder) Counselor
  • Petersburg, VA
  • NPI 1306509724
  NPD

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

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1922761352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 PINE RIDGE RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238051320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 PINE RIDGE RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238051320",
            "telephone_number": "804-714-5998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PROFESSIONAL SERV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "STOKES",
        "authorized_official_first_name": "ANTOINITA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CONSULTANT",
        "authorized_official_telephone_number": "804-613-0087"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0709024300",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QMHP",
            "identifier": "0733006270",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0733006270",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE ABUSE",
            "identifier": "0709024300",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QMHP ADULT",
            "identifier": "0732008263",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valecia Jackson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Addiction (Substance Use Disorder) Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; 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.