Carla Jack, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CSW006674 Issued in GA

Practice address

4151 Memorial Dr Ste 209C
Decatur, GA 30032-1597

Phone

(404) 508-0078

Fax

(404) 508-0071

NPI assigned

Nov 5, 2020

Sex

Female

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)

Enrolled

State licenses

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

{
    "created_epoch": "1604534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1992306989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4151 MEMORIAL DR STE 209C",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321597",
            "telephone_number": "404-508-0078",
            "fax_number": "404-508-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 MEMORIAL DR STE 209C",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321597",
            "telephone_number": "404-508-0078",
            "fax_number": "404-508-0071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "CARLA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-05",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "CSW006674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thersa S Ivory, RN
• Constance D'Shawna Ivy, RN
• Laklieshia Monique Izzard, LPC
• J D Wallace Enterprises LLC
• Lynnda Ann Jabaley, R. PH.
• Jackie Haar LCSW, LLC
• Julie Diane Elizabeth Jackson-Murphy, M.D.
• Patrice M Jackson-Weathers, CNA
• Althea Brenda Jackson, RN
• Amanda Z. Jackson, O.T.

• Mental Health Counselor in Decatur, GA
• Providers in Decatur, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.