CHARLIE JACKSON (NPI# 1548604226) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548604226 |
| Entity Type | Individual |
| Full Name | CHARLIE JACKSON |
| Credential | RMHCI |
| Practice Address |
1831 N Crystal Lake Dr Lakeland FL 33801-5902 |
| Mailing Address |
Po Box 1559 Bartow FL 33831-1559 |
| Practice Telephone | 8635190575 |
| Mailing Telephone | 8635190575 |
| Mailing Fax Number | 8635829251 |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2018-04-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
IMH16970 | FL | Behavioral Health & Social Service Providers |
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
1831 N CRYSTAL LAKE DR |
| City | LAKELAND |
| State | FL |
| Zip Code | 33801-5902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437476694 | Jennifer Maxius | Counselor | 1831 N Crystal Lake Dr, Lakeland, FL 33801-5902 | 2010-04-28 |
| 1235745258 | James Stokes | Counselor | 1831 N Crystal Lake Dr, Lakeland, FL 33801-5902 | 2020-09-16 |
| 1316557291 | Shelly Pinkerton | Counselor | 1831 N Crystal Lake Dr, Lakeland, FL 33801-5902 | 2020-08-05 |
| 1609492776 | Jessica Lynn Morris | Counselor | 1831 N Crystal Lake Dr, Lakeland, FL 33801-5902 | 2020-06-24 |
| 1316563406 | Mikayla Smith | Counselor | 1831 N Crystal Lake Dr, Lakeland, FL 33801-5902 | 2020-06-24 |
| 1598381931 | Audrey Cook | Counselor | 1831 N Crystal Lake Dr, Lakeland, FL 33801-5902 | 2020-06-22 |
| 1861015505 | Estela Villarreal | Community Health Worker | 1831 N Crystal Lake Dr, Lakeland, FL 33801-5902 | 2020-05-28 |
| 1306469051 | Sherrel Wiggins | Counselor | 1831 N Crystal Lake Dr, Lakeland, FL 33801-5902 | 2020-05-28 |
| 1558998013 | Brandon Saldoriga | Counselor | 1831 N Crystal Lake Dr, Lakeland, FL 33801-5902 | 2020-03-25 |
| 1669008215 | Oriana Fuguet Machado | Counselor | 1831 N Crystal Lake Dr, Lakeland, FL 33801-5902 | 2020-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508473802 | Camryn Nichole White | Assistant Behavior Analyst | 301 South Florida Ave, Lakeland, FL 33801 | 2020-09-30 |
| 1932719242 | Jimia Watkins | Home Health Aide | 2410 Lakeview St, Lakeland, FL 33801 | 2020-08-03 |
| 1396366886 | Erin Zimmer | Health Educator | 491 Lake Parker Ave, Lakeland, FL 33801 | 2020-05-06 |
| 1013473206 | Madelyn Claire Burley | Occupational Therapist | 1215 East Orange Street, Lakeland, FL 33801 | 2019-02-13 |
| 1992260319 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 1617 Us Highway 98 S, Lakeland, FL 33801 | 2019-02-11 |
| 1669908836 | Integrative Physical Medicine of Lakeland LLC | Specialist | 1205 East Magnolia St, Suite 105, Lakeland, FL 33801 | 2017-05-10 |
| 1689111502 | Daryl Dowding | Counselor | 390 Alcaia Rd., Lakeland, FL 33801 | 2017-01-30 |
| 1023481926 | Joseph D'alessandro | Specialist/Technologist | 111 Lake Hollingsworth Dr Box 4334, Lakeland, FL 33801 | 2015-11-02 |
| 1588030894 | Donna Lee Buckner | Specialist/Technologist | 111 Mosswood Road, Lakeland, FL 33801 | 2015-08-20 |
| 1144635780 | Donna Paige Mccraney | Nurse Practitioner | 111 Lake Hollingsworth Drive, Florida Southern College Student Health Center, Lakeland, FL 33801 | 2014-06-23 |
| Find all providers in zip 33801 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124626734 | Rowena Allison Barnett | Counselor | 4730 Lakeland Highlands Rd, Lakeland, FL 33813-3125 | 2020-10-15 |
| 1013525039 | Marah Mcaleer | Counselor | 5601 Bloomfield Blvd, Lakeland, FL 33810-8234 | 2020-07-15 |
| 1801417993 | Annie G Leboeuf | Counselor | 7355 Us Highway 98 N, Lakeland, FL 33809-2102 | 2020-04-30 |
| 1477172971 | Florida Counseling Solutions LLC | Counselor | 122 E Main St # 274, Lakeland, FL 33801-4655 | 2020-04-14 |
| 1114553757 | Megan Nance | Counselor | 50 Lake Morton Dr, Lakeland, FL 33801-5343 | 2020-03-16 |
| 1114557360 | Pinder Counseling LLC | Counselor | 4740 Cleveland Heights Blvd Ste 1, Lakeland, FL 33813-2187 | 2020-01-16 |
| 1174162093 | Deborah Beall Boynton | Counselor | 219 Hillcrest St, Lakeland, FL 33815 | 2019-12-23 |
| 1295377745 | Mary Ann Veronica Santiago | Counselor | 4745 Old Road 37, Lakeland, FL 33813-2031 | 2019-10-16 |
| 1407498298 | Altovise L Davis | Counselor | 627 Carolyn Dr, Lakeland, FL 33803-4856 | 2019-10-13 |
| 1255988895 | Glenna Mary Denis | Counselor | 3421 Sleepy Hill Oaks St, Lakeland, FL 33810-3561 | 2019-08-19 |
| Find all providers in LAKELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.