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MRS. DEWANDA B. JACKSON LPC, CPCS, EAU-C
NPI 1184761561
Counselor - Professional in Decatur, GA

Active since February 01, 2007PECOS EnrolledAccepts Medicare Assignment
4319 COVINGTON HWY STE 110, DECATUR, GA 30035(404) 286-0054(404) 286-0064 Get Directions Write a Review

NPPES record last updated: June 23, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mrs. Dewanda B. Jackson Lpc, Cpcs, Eau-c NPPES

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

MRS. DEWANDA B. JACKSON LPC, CPCS, EAU-C (NPI 1184761561) is an individual professional provider in Decatur, Georgia, licensed in Georgia (LPC002390) and active in the NPI registry since February 2007. She is enrolled in Medicare PECOS and is a graduate of Other (1992).

NPPES Registry Identity

NPI1184761561
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameMRS. DEWANDA B. JACKSONCredential: LPC, CPCS, EAU-C
Location Address4319 COVINGTON HWY STE 110Decatur, GA 30035-1206
Mailing AddressPo Box 1501Lithonia, GA 30058-1007 · (404) 286-0054 · Fax (404) 286-0064
Phone(404) 286-0054
Fax(404) 286-0064
Sole ProprietorNo
Medical School CMSOtherGraduated 1992
Enumeration DateFebruary 1, 2007
Last NPPES UpdateJune 23, 2021
NPPES CertifiedJune 23, 2021
✔ NPI 1184761561 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in GA · LPC002390
4319 COVINGTON HWY STE 110, Decatur, GA 30035
Open in Google Maps ↗

Other Identifiers 1

OtherLPC002390GA · Professional Counselor

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Dewanda B. Jackson Lpc, Cpcs, Eau-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8325393507
PECOS Enrollment IDI20250801002674
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Dewanda Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Marvelous Light Consultants
0.4 mi
Professional
4484 COVINGTON HWY, SUITE 100A
Decatur, GA 30035
  • Reassigned Medicare billing, Georgia enrollment
  • 2 clinicians in this Medicare group
NPI 1922145325 (404) 286-0054

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Dewanda Jackson's NPI number?

The NPI number for Dewanda Jackson is 1184761561. It was assigned to this individual provider in the NPPES registry on February 1, 2007.

Where is Dewanda Jackson located?

Dewanda Jackson practices at 4319 Covington Hwy Ste 110, Decatur, GA 30035. The listed phone number is (404) 286-0054.

What is Dewanda Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Dewanda Jackson enrolled in Medicare?

Yes. Dewanda Jackson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Dewanda Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Dewanda Jackson reassigns Medicare benefits to Marvelous Light Consultants (Decatur, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Dewanda Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Dewanda Jackson was last updated on June 23, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.