DR. CHARLES W JACKSON (NPI# 1851315766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851315766 |
| Entity Type | Individual |
| Full Name | DR. CHARLES W JACKSON |
| Credential | PH.D. |
| Practice Address |
210 University Plaza Dr Conway SC 29526-8978 |
| Mailing Address |
5315 N Kings Hwy Pmb 120 Myrtle Beach SC 29577-2534 |
| Practice Telephone | 8433472550 |
| Mailing Telephone | 8435032000 |
| Mailing Fax Number | 8432723032 |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC1900X |
Psychologist Specialization: Counseling |
182 | SC | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | COUNSELING PSYCHOLOGIST | 182 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457896839 | Charles Jackson | Counselor | 2911 Penick St, Shreveport, LA 71109-4337 | 2016-12-21 |
| 1043655681 | Charles D Jackson | Driver | 4856 W.12th, Suite 1, Cleveland, OH 44109-3424 | 2013-05-09 |
| 1437594553 | Charles Jackson | Social Worker | 18712 Quarry St, Riverview, MI 48193-4527 | 2013-05-02 |
| 1508154105 | Charles Gilbert Jackson Jr. | Psychiatry & Neurology | 88 Crescent St, Northampton, MA 01060-2115 | 2011-07-16 |
| 1457669848 | Charles Edward Jackson Jr. | Psychologist | 1407 Healing Water Lane, N.las Vegas, NV 89031 | 2010-09-20 |
| 1588994081 | Charles Dustin Jackson | Counselor | 5004 Nw 26th St, Oklahoma City, OK 73127-1722 | 2010-01-05 |
| 1508985250 | Charles Arthur Jackson Jr. | Chiropractor | 2455 E Hill Rd, Grand Blanc, MI 48439 | 2007-03-27 |
| 1760535926 | Charles Jackson | Podiatrist | 820 N Dalmont St, Hobbs, NM 88240-5214 | 2007-01-19 |
| 1982769840 | Charles Jackson | Dentist | 3540 82nd St, Jackson Heights, NY 11372-5159 | 2006-12-22 |
| 1437224813 | Charles Wesley Jackson Jr. | Psychologist | 2980 Washington Blvd, Cleveland Heights, OH 44118-2450 | 2006-11-21 |
| Street Address |
210 UNIVERSITY PLAZA DR |
| City | CONWAY |
| State | SC |
| Zip Code | 29526-8978 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457975237 | Terri L Champion | Massage Therapist | 172 Waccamaw Medical Park Court, Conway, SC 29526 | 2020-06-08 |
| 1689204398 | Alayna Defalco | Clinical Exercise Physiologist | 1320 501 Business, Unit E, Conway, SC 29526 | 2020-01-22 |
| 1124672662 | Proxsys Rx - Sc, LLC | Pharmacy | 300 Singelton Ridge Road, Conway, SC 29526 | 2019-08-01 |
| 1598227431 | Surgery Center of Conway Inc | Clinic/Center | 1405 Main Street, Conway, SC 29526 | 2019-04-01 |
| 1801374962 | Trevor James Hess | Specialist/Technologist | 905 One Landon Loop, Conway, SC 29526 | 2018-08-01 |
| 1851800817 | Katherine Ann Nimphius | Behavioral Analyst | 105 Timberline Dr, Conway, SC 29526 | 2017-09-21 |
| 1922544253 | William Houck | Specialist/Technologist | 925 One Landon Loop, Conway, SC 29526 | 2017-01-10 |
| 1952857278 | Courtney Jeanette Smith | Counselor | 164 Waccamaw Medical Park Dr., Conway, SC 29526 | 2016-08-28 |
| 1336502632 | Jebediah S. Christy, D.d.s - Conway, Pllc | Dentist | 2756 Church St, Conway, SC 29526 | 2016-04-04 |
| 1447615208 | Abl Enterprises, LLC | Optometrist | 113 Citadel Drive, Conway, SC 29526 | 2015-12-22 |
| Find all providers in zip 29526 | ||||
| Taxonomy Code | 103TC1900X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Counseling |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295910974 | Kenneth Aldwin Priest | Psychologist | 2323 Washington Ave, Conway, AR 72032-2766 | 2007-12-31 |
| 1003369950 | Cariann M Bergner-moore | Psychologist | 1312 Donaghey Ave, Conway, AR 72034-3807 | 2016-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588262497 | Raising Hope Inc | Psychologist | 223 E Main St Ste 101, Rock Hill, SC 29730-4571 | 2020-10-13 |
| 1053941898 | Mary Ashley Allen | Psychologist | 1011 Tiger Blvd Ste 610, Clemson, SC 29631-1401 | 2020-01-21 |
| 1568027662 | Marshall Dewayne Blackwell | Psychologist | 3 Bishop St, Inman, SC 29349-1515 | 2019-05-03 |
| 1083108187 | Andrew Scott Gibson | Psychologist | 11 N Irvine St Ste 6, Greenville, SC 29601-4902 | 2018-06-21 |
| 1548706567 | Laura Haley Creel | Psychologist | 126 Langwell Dr, Anderson, SC 29621-3678 | 2017-01-14 |
| 1699217364 | Counseling and Psychological Services of The Upstate | Psychologist | 224 Holly Ave, Clemson, SC 29631-2347 | 2016-11-13 |
| 1790235224 | Daniel Dean Trent | Psychologist | 444 Saint Julian Pl, North Augusta, SC 29860-8791 | 2016-10-07 |
| 1841676970 | Aubrey Ball | Psychologist | 107 Birch Hollow Dr, Columbia, SC 29229-8207 | 2015-07-30 |
| 1023492253 | Kristen Stevens | Psychologist | 319 Garlington Rd Ste C3, Greenville, SC 29615 | 2015-07-17 |
| 1891131520 | George Atkinson | Psychologist | 226 Frontage Rd, Clemson, SC 29631-1642 | 2013-05-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.