Active NPI
Victoria Jackson, LCSWA
- Clinical Social Worker
- Goldsboro, NC
National Provider Identifier
1932885324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P018890
- Practice address
- 208 Malloy St Ste B
Goldsboro, NC 27534-4478 - Phone
- (984) 520-6080
- NPI assigned
- Jun 22, 2023
- Last updated
- Jul 17, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | P018890 | NC | Primary |
Addresses
Primary practice location
208 Malloy St Ste B
Goldsboro, NC 27534-4478
Mailing address
7629 Purfoy Rd # RF
Fuquay Varina, NC 27526-9549
Phone (919) 285-4802
Other practice location 1
7629 Purfoy Rd
Fuquay Varina, NC 27526-9549
Phone (919) 285-4802
Other names 1
- Victoria Shailisa Jackson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P018890 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pride in North Carolina, LLC | Mental Health | Past | Accepting new patients |
| Pride in North Carolina, LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Greenville, NC
- NPI 1760420186
Mental Health
-
- Community/Behavioral Health Agency
- Jacksonville, NC
- NPI 1821136581
Mental Health
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721174400000",
"number": "1932885324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7629 PURFOY RD # RF",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275269549",
"telephone_number": "919-285-4802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 MALLOY ST STE B",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275344478",
"telephone_number": "984-520-6080"
}
],
"practiceLocations": [
{
"address_1": "7629 Purfoy Rd",
"address_purpose": "LOCATION",
"city": "Fuquay Varina",
"state": "NC",
"postal_code": "275269549",
"country_code": "US",
"telephone_number": "919-285-4802",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "VICTORIA",
"credential": "LCSWA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-22",
"last_updated": "2024-07-17",
"certification_date": "2024-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P018890",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "VICTORIA",
"last_name": "JACKSON",
"middle_name": "SHAILISA",
"credential": "LCSWA",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Goldsboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.