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NPI Code Detail

MEDICARE: JAMIRAH JACKSON LPC

MEDICARE: JAMIRAH JACKSON LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0701015814VA

General Provider Information

NPI Number : 1063367233
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIRAH JACKSON LPC
Provider Business Mailing Address
First Line : 1900 ABBERLY CIR APT 1167
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-3257
Country : US
Telephone Number : 202-321-1605
Fax Number :
Provider Business Practice Location Address
First Line : 233 E MAIN ST STE 401
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-5045
Country : US
Telephone Number : 406-219-7835
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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