=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902751167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAJESTIC CHRISTIAN COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2026
-----------------------------------------------------
Last Update Date | 03/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 DAVID DR APT F25
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-4870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-284-2452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 DAVID DR APT F25
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-4870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-284-2452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/CEO
-----------------------------------------------------
Name | NATASHA JACKSON JACKSON
-----------------------------------------------------
Credential | LCAS
-----------------------------------------------------
Telephone | 252-508-2173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------