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SAMANTHA LACHELLE JACKSON LCPC
NPI 1609438225
Counselor - Professional in Baltimore, MD

Active since July 03, 2019PECOS Enrolled
4317 HARFORD RD, BALTIMORE, MD 21214(443) 708-7510(410) 275-0992 Get Directions Write a Review

NPPES record last updated: June 5, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jun 5, 2023, Jun 15, 2021, Jul 3, 2019 (3 updates tracked since 2019).

About Samantha Lachelle Jackson Lcpc NPPES

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

SAMANTHA LACHELLE JACKSON LCPC (NPI 1609438225) is an individual professional provider in Baltimore, Maryland, licensed in Maryland (LC11555) and active in the NPI registry since July 2019. She is enrolled in Medicare PECOS and is a graduate of Other (2016).

NPPES Registry Identity

NPI1609438225
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameSAMANTHA LACHELLE JACKSONCredential: LCPC
Location Address4317 HARFORD RDBaltimore, MD 21214-3118
Mailing Address4317 Harford RdBaltimore, MD 21214-3118 · (410) 275-0994 · Fax (410) 275-0992
Phone(443) 708-7510
Fax(410) 275-0992
Sole ProprietorNo
Medical School CMSOtherGraduated 2016
Enumeration DateJuly 3, 2019
Last NPPES UpdateJune 5, 20233 updates tracked since enumeration
NPPES CertifiedJune 5, 2023
✔ NPI 1609438225 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 MD · LC11555✔ Licensed in MD · LGP9650
4317 HARFORD RD, Baltimore, MD 21214
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Other Identifiers 1

Medicaid210292700MD

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samantha Lachelle Jackson Lcpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9830566371
PECOS Enrollment IDI20260314000007
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 Samantha Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Jacksons Jubilee LLC
Same address
Professional
4317 HARFORD RD
Baltimore, MD 21214
  • Reassigned Medicare billing, Maryland enrollment
NPI 1588520563 (443) 653-9506

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

Other Providers at the Same Location NPPES 14

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

THRIVE GROUP INC
Community/Behavioral Health
4317 HARFORD RD
BALTIMORE, MD 21214
Baltimore City (443) 504-7427
STEPHANIE RAY ADT
Counselor
4317 HARFORD RD
BALTIMORE, MD 21214
Baltimore City (410) 275-0994
HELPING OTHERS MANAGE EMOTIONS
Counselor (Mental Health)
4317 HARFORD RD
BALTIMORE, MD 21214
Baltimore City (443) 708-7510
MR. ROY HAMILTON MACK JR. LGPC
Counselor (Professional)
4317 HARFORD RD
BALTIMORE, MD 21214
Baltimore City (443) 224-5443
NAOMI ESTELLA GUTENG LMSW
Social Worker
4317 HARFORD RD
BALTIMORE, MD 21214
Baltimore City (410) 275-0994
CANDACE VICE
Social Worker
4317 HARFORD RD
BALTIMORE, MD 21214
Baltimore City (410) 275-0994
HELPING OTHERS MANAGE EMOTIONS THERAPEUTIC SERVICES LLC
Community/Behavioral Health
4317 HARFORD RD
BALTIMORE, MD 21214
Baltimore City (443) 708-7510
JACKSONS JUBILEE LLC
Counselor (Professional)
4317 HARFORD RD
BALTIMORE, MD 21214
Baltimore City (443) 653-9506

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 Samantha Jackson's NPI number?

The NPI number for Samantha Jackson is 1609438225. It was assigned to this individual provider in the NPPES registry on July 3, 2019.

Where is Samantha Jackson located?

Samantha Jackson practices at 4317 Harford Rd, Baltimore, MD 21214. The listed phone number is (443) 708-7510.

What is Samantha Jackson's specialty?

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

Is Samantha Jackson enrolled in Medicare?

Yes. Samantha Jackson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Samantha Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samantha Jackson reassigns Medicare benefits to Jacksons Jubilee LLC (Baltimore, MD). 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 Samantha 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 Samantha Jackson was last updated on June 5, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.