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1942577200 NPI number — DONALD JEFFERSON JACKSON MSW LCSW LCAS-A

NPI Number: 1942577200
Health Care Provider/Practitioner: DONALD JEFFERSON JACKSON MSW LCSW LCAS-A

Information about “1942577200” NPI (DONALD JEFFERSON JACKSON MSW LCSW LCAS-A) exists in 1942577200 in HTML format HTML  |  1942577200 in plain Text format TXT  |  1942577200 in PDF (Portable Document Format) PDF  |  1942577200 in an XML format XML  formats.

NPI Number : 1942577200 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942577200",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "DONALD",
    "MiddleName": "JEFFERSON",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "MSW LCSW LCAS-A",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JACKSON",
    "OtherFirstName": "JEFF",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "434 ATKINSON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAURINBURG",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28352-3714",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "910-506-2008",
    "MailingAddressFaxNumber": "910-506-2010",
    "FirstLinePracticeLocationAddress": "434 ATKINSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAURINBURG",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28352-3714",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-506-2008",
    "PracticeLocationAddressFaxNumber": "910-506-2010",
    "EnumerationDate": "11/30/2011",
    "LastUpdateDate": "03/10/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "C007538",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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