ANTOINE DESHAWN JACKSON MA, LPCC
NPI 1174278048
Counselor - Mental Health in Roseville, MN

Q: What is Antoine Jackson's NPI number?

The NPI number for Antoine Jackson is 1174278048. It was assigned to this individual provider in the NPPES registry on February 18, 2022.

Q: What is Antoine Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Antoine Jackson was last updated on November 14, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 18, 2022

2335 WOODBRIDGE ST APT 338, ROSEVILLE, MN 55113(612) 715-4071 Get Directions Write a Review

NPPES record last updated: November 14, 2024. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Nov 14, 2024, Feb 18, 2022 (2 updates tracked since 2022).

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About Antoine Deshawn Jackson Ma, Lpcc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANTOINE DESHAWN JACKSON MA, LPCC (NPI 1174278048) is an individual mental health provider in Roseville, Minnesota, licensed in Minnesota (3145) and active in the NPI registry since February 2022.

NPPES Registry Identity

NPI1174278048

Entity TypeIndividualMale

Primary Taxonomy101YM0800X

Provider Legal NameANTOINE DESHAWN JACKSONCredential: MA, LPCC

Location Address2335 WOODBRIDGE ST APT 338Roseville, MN 55113-4763

Mailing Address2335 Woodbridge St Apt 338Roseville, MN 55113-4763 · (612) 715-4071

Phone(612) 715-4071

Sole ProprietorYes

Enumeration DateFebruary 18, 2022

Last NPPES UpdateNovember 14, 20242 updates tracked since enumeration

NPPES CertifiedNovember 14, 2024

✔ NPI 1174278048 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in MN · 3145

2335 WOODBRIDGE ST APT 338, Roseville, MN 55113

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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SUPPORTIVE CHANGE COUNSELING & CONSULTING

Counselor (Mental Health)

2335 WOODBRIDGE ST APT 338
ROSEVILLE, MN 55113

Ramsey County (612) 367-7287

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Antoine Jackson's NPI number?

The NPI number for Antoine Jackson is 1174278048. It was assigned to this individual provider in the NPPES registry on February 18, 2022.

Where is Antoine Jackson located?

Antoine Jackson practices at 2335 Woodbridge St Apt 338, Roseville, MN 55113. The listed phone number is (612) 715-4071.

What is Antoine Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Antoine Jackson was last updated on November 14, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.