Jackie Jerome Johnson Sr., LCDC-I

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1715 26TH St
Lubbock, TX 79411-1524

Phone

(806) 780-8300

Fax

(806) 780-8383

NPI assigned

Oct 11, 2017

Sex

Male

Sole proprietor

No

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

Practice roles

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.

• Managed Care Center for Addictive and Other Disorders Inc

  • Point of Service
  • Lubbock, TX
  • NPI 1790043404
  NPD (past)

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

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507680000000",
    "number": "1982114344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 26TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794111524",
            "telephone_number": "806-780-8300",
            "fax_number": "806-780-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 26TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794111524",
            "telephone_number": "806-780-8300",
            "fax_number": "806-780-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACKIE",
        "middle_name": "JEROME",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "LCDC-I",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-11",
        "last_updated": "2017-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elise Michella Johnson, PHARM D.
• Erin Ruth Johnson, OT
• Esther Yvonne Johnson, MD
• Heather Johnson, PHARMD
• Heenan Johnson III, DDS
• Jake Johnson, CRNA
• James Matthew Johnson, D.C.
• John Cameron Johnson, DDS
• Joseph Henry Johnson
• Judith Faye Johnson, F.N.P.

• Addiction (Substance Use Disorder) Counselor in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Addiction (Substance Use Disorder) Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2017; 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.