DR. FREDERICKA ARLENE JACKSON (NPI# 1922089531) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922089531 |
| Entity Type | Individual |
| Full Name | DR. FREDERICKA ARLENE JACKSON |
| Credential | PH.D. CAC II |
| Practice Address |
38815 Dequindre Rd Troy MI 48083-5769 |
| Mailing Address |
43220 Fountain Dr Sterling Heights MI 48313-2394 |
| Practice Telephone | 2482507323 |
| Mailing Telephone | 5865329948 |
| Mailing Fax Number | 5862632762 |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
6301008884 | MI | Behavioral Health & Social Service Providers |
| X | 103TC0700X |
Psychologist Specialization: Clinical |
6301008884 | MI | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134590672 | Fredericka Jackson | Behavioral Analyst | 9550 United Plaza Blvd, Ste 702 -n, Baton Rouge, LA 70809-0200 | 2015-10-09 |
| 1457993750 | Fredericka Jackson | Nurse Practitioner | 6901 S 84th St, La Vista, NE 68128-2127 | 2019-10-08 |
| Street Address |
38815 DEQUINDRE RD |
| City | TROY |
| State | MI |
| Zip Code | 48083-5769 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053302323 | Robert G Saieg | Obstetrics & Gynecology | 38815 Dequindre Rd, Ste 101, Troy, MI 48083-6810 | 2005-11-04 |
| 1780928614 | True Gynecology Pllc | Obstetrics & Gynecology | 38815 Dequindre Rd, Suite 101, Troy, MI 48083-6810 | 2012-11-15 |
| 1790963171 | Changhee Kim Md Phd Plc | Family Medicine | 38815 Dequindre Rd, Suite 103, Troy, MI 48083-6810 | 2008-02-07 |
| 1649321688 | Robert G Saieg Md PC | Obstetrics & Gynecology | 38815 Dequindre Rd, Ste 101, Troy, MI 48083-6810 | 2007-01-16 |
| 1154482248 | Sarala Ravikant Md PC | Internal Medicine | 38815 Dequindre Rd, Ste 100, Troy, MI 48083 | 2006-12-12 |
| 1215918479 | Changhee Kim | Family Medicine | 38815 Dequindre Rd, Ste 103, Troy, MI 48083 | 2005-11-07 |
| 1518958735 | Steven M Dean | Obstetrics & Gynecology | 38815 Dequindre Rd, Suite 101, Troy, MI 48083-6810 | 2005-11-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417420449 | Thapasvi Muttirevula | Physical Therapist | 2422 Cedar Knoll Dr, Troy, MI 48083 | 2019-01-02 |
| 1114418290 | Ann Katchke | Physical Therapist | 3179 Livernois Rd, Troy, MI 48083 | 2018-05-23 |
| 1518485945 | Risa Rae Mendelson | Counselor | 1059 Owendale Street, Troy, MI 48083 | 2017-09-06 |
| 1497277115 | Gassan Asadi | Pharmacist | 215 E Big Beaver Rd Ste 500, Troy, MI 48083 | 2017-07-14 |
| 1528510328 | Dylan Skye Polasko | Behavioral Analyst | 2221 E 4th St, #101, Troy, MI 48083 | 2016-10-27 |
| 1235683061 | Sadia Ghazi | Technician, Other | 3178 Daley Dr., Troy, MI 48083 | 2016-08-10 |
| 1548664345 | Amber Leigh Ernst | Social Worker | 1225 E. Big Beaver Road, Troy, MI 48083 | 2014-10-22 |
| 1356782411 | Michelle Louise Knoblock | Nurse Anesthetist, Certified Registered | 1560 E Maple Rd Ste 100, Troy, MI 48083 | 2013-07-17 |
| 1437400728 | Oakland Physicians Surgery Center | Clinic/Center | 1560 E. Maple Road, Suite 100, Troy, MI 48083 | 2012-09-26 |
| 1861748238 | Pro Med Substance Abuse Program LLC | Psychologist | 2891 E. Maple Rd. Suite 200, Troy, MI 48083 | 2012-08-03 |
| Find all providers in zip 48083 | ||||
| Taxonomy Code | 103TA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508202920 | Abaris Health | Psychologist | 2501 Rochester Ct, Troy, MI 48083-1875 | 2013-05-13 |
| 1861748238 | Pro Med Substance Abuse Program LLC | Psychologist | 2891 E. Maple Rd. Suite 200, Troy, MI 48083 | 2012-08-03 |
| 1285800870 | Deborah Ann Bogle | Psychologist | 543 Vanderpool Dr, Troy, MI 48083-5151 | 2008-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972137883 | Lazarusman Consulting, Pllc | Psychologist | 2416 Peck St, Muskegon Hts, MI 49444-1431 | 2020-02-29 |
| 1861031189 | Christina M Kaplan, Pllc | Psychologist | 39520 Woodward Ave Ste 201, Bloomfield Hills, MI 48304-5057 | 2020-01-03 |
| 1184273716 | Drbrandi | Psychologist | 16250 Northland Dr Ste 240, Southfield, MI 48075-5227 | 2019-09-06 |
| 1790145548 | Cecil Cosey IIi | Psychologist | 11000 W Micnichols, Detroit, MI 48238 | 2016-03-07 |
| 1003161282 | Michael George Brock | Psychologist | 2514 Biddle Avenue, Wyandotte, MI 48192 | 2012-07-13 |
| 1972860005 | Samaritas | Psychologist | 128 S Cochran Ave, Charlotte, MI 48813-1510 | 2012-04-13 |
| 1619254042 | Kathryn Bartz | Psychologist | 500 Barfield Dr., Hastings, MI 49058-9018 | 2011-11-14 |
| 1609100627 | Laytoya Chevette Lambeth | Psychologist | 51255 Luke Ln, Novi, MI 48374-1004 | 2009-09-23 |
| 1902059868 | Michele Alaine Pischea | Psychologist | 1231 East Michigan Ave., Suite 201, East Lansing, MI 48823 | 2008-10-23 |
| 1194909093 | Bonita M Pedrosi | Psychologist | 675 Pearson St, Ferndale, MI 48220-3302 | 2007-12-27 |
| 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.