JUSTIN JACKSON LPC
NPI 1235788902
Counselor - Professional in Glen Allen, VA

Q: What is Justin Jackson's NPI number?

The NPI number for Justin Jackson is 1235788902. It was assigned to this individual provider in the NPPES registry on September 5, 2019.

Q: What is Justin 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 Justin Jackson was last updated on August 20, 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.

Active since September 05, 2019PECOS EnrolledAccepts Medicare Assignment

4212 PARK PLACE CT, GLEN ALLEN, VA 23060(804) 332-5950(804) 728-1086 Get Directions Write a Review

NPPES record last updated: August 20, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 20, 2021, Sep 5, 2019 (2 updates tracked since 2019).

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About Justin Jackson Lpc NPPES

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

JUSTIN JACKSON LPC (NPI 1235788902) is an individual professional provider in Glen Allen, Virginia, licensed in Virginia (0701008565) and active in the NPI registry since September 2019. He is enrolled in Medicare PECOS and is a graduate of Other (2013).

NPPES Registry Identity

NPI1235788902

Entity TypeIndividualMale

Primary Taxonomy101YP2500X

Provider Legal NameJUSTIN JACKSONCredential: LPC

Location Address4212 PARK PLACE CTGlen Allen, VA 23060-3314

Mailing Address4212 Park Place CtGlen Allen, VA 23060-3314 · (804) 332-5950 · Fax (804) 728-1086

Phone(804) 332-5950

Fax(804) 728-1086

Sole ProprietorNo

Medical School CMSOtherGraduated 2013

Enumeration DateSeptember 5, 2019

Last NPPES UpdateAugust 20, 20212 updates tracked since enumeration

NPPES CertifiedAugust 20, 2021

✔ NPI 1235788902 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in VA · 0701008565

Also ListedCounselorTaxonomy 101Y00000X · License 0701008565 (VA)

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 0701008565 (VA)

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 0701008565 (VA)

4212 PARK PLACE CT, Glen Allen, VA 23060

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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

Justin Jackson Lpc 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 ID7113362757

PECOS Enrollment IDI20240305001845

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 Justin Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Virginia Center For Addiction Medicine

Same address

Addiction Medicine

4212 PARK PLACE CT
Glen Allen, VA 23060

Reassigned Medicare billing, Virginia enrollment
16 clinicians in this Medicare group

NPI 1477091247 (804) 332-5950

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

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Group psychotherapy 90853

Group psychotherapy involves individuals discussing their issues in a group setting, led by a professional therapist. It provides a supportive environment where members can learn from each other's experiences, gain different perspectives, and develop new ways to handle challenges.

30 services15 patients

Other Providers at the Same Location NPPES 8

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

KATHERINE LOUISE HASKINS LPC, NCC

Counselor (Professional)