DR. ANGELA DECARLA JACKSON PH.D., LCPC, LMHC
NPI 1194267476
Counselor - Professional in South Bend, IN

Q: What is Angela Jackson's NPI number?

The NPI number for Angela Jackson is 1194267476. It was assigned to this individual provider in the NPPES registry on November 17, 2016.

Q: What is Angela Jackson's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Angela Jackson was last updated on June 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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 November 17, 2016PECOS Enrolled

1251 N EDDY ST STE 200, SOUTH BEND, IN 46617(312) 798-9755 Get Directions Write a Review

NPPES record last updated: June 25, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 25, 2025, Jun 11, 2025, May 6, 2020 and 2 more (5 updates tracked since 2016).

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About Dr. Angela Decarla Jackson Ph.d., Lcpc, Lmhc NPPES

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

DR. ANGELA DECARLA JACKSON PH.D., LCPC, LMHC (NPI 1194267476) is an individual professional provider in South Bend, Indiana, licensed in Indiana (39004648A) and active in the NPI registry since November 2016. She is enrolled in Medicare PECOS, maintains a secondary practice location in South Bend, and is a graduate of Other (2004).

NPPES Registry Identity

NPI1194267476

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameDR. ANGELA DECARLA JACKSONCredential: PH.D., LCPC, LMHC

Location Address1251 N EDDY ST STE 200South Bend, IN 46617-1478

Mailing Address1251 N Eddy St Ste 200South Bend, IN 46617-1478 · (312) 798-9755

Phone(312) 798-9755

Sole ProprietorNo

Medical School CMSOtherGraduated 2004

Enumeration DateNovember 17, 2016

Last NPPES UpdateJune 25, 20255 updates tracked since enumeration

NPPES CertifiedJune 25, 2025

✔ NPI 1194267476 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

Licenses✔ Licensed in IN · 39004648A✔ Licensed in IL · 180.011258

1251 N EDDY ST STE 200, South Bend, IN 46617

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Secondary Practice Location 1

Location 11251 N Eddy St Ste 200South Bend, IN 46617-1478 · Phone (312) 798-9755

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Angela Decarla Jackson Ph.d., Lcpc, Lmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5991295339

PECOS Enrollment IDI20251110000562

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.

Other Providers at the Same Location NPPES 12

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

BRIGHT CARE LLC

Home Health