Angela Decarla Jackson, PH.D., LCPC, LMHC
NPI 1194267476ActiveIndividual· Counselor, Professional· South Bend, IN
Counselor, Professional (PH.D., LCPC, LMHC) in South Bend, Indiana, licensed in IN and IL, with an NPI issued in November 2016. Enrolled in Medicare as practitioner - mental health counselor and practitioner - mental health counselor.
Overview
| NPI | 1194267476 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PH.D., LCPC, LMHC |
| Sole proprietor | No |
| NPI issued | Nov 17, 2016 |
| Last updated in NPPES | Jun 25, 2025 |
| Certified by provider | Jun 25, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Professional Primary | 101YP2500X | 39004648A | IN |
| Counselor, Professional | 101YP2500X | 180.011258 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Mental Health Counselor (IL); Practitioner - Mental Health Counselor (IN) |
|---|
Education and affiliations
| Graduation year | 2004 |
|---|---|
| Medicare specialty | Mental Health Counselor |
Other professional counselors in South Bend
- 1083400931
- 1336574748
- 1548046105
- 1700196698
- 1861721136
- 1881215374
- 1891294500
- 1841748449
- 1679783187
- 1710164603
- 1497398762