Deirdre Renee' Jackson, PHD LCMHCS LPC NCC
NPI 1215343009ActiveIndividual· Counselor, Professional· Clarksville, TN
Counselor, Professional (PHD LCMHCS LPC NCC) with Brightside Medical PC, practicing in Clarksville, Tennessee. Enrolled in Medicare as practitioner - mental health counselor.
Overview
| NPI | 1215343009 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PHD LCMHCS LPC NCC |
| Sole proprietor | Yes |
| NPI issued | Jul 1, 2014 |
| Last updated in NPPES | Jul 20, 2022 |
| Certified by provider | Jul 20, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Professional Primary | 101YP2500X | 5911 | LA |
| Counselor, Mental Health | 101YM0800X | S12958 | NC |
| Counselor, Professional | 101YP2500X | 1744 | TN |
| Counselor, Professional | 101YP2500X | 77544 | TX |
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 (TN) |
|---|
Education and affiliations
| Graduation year | 1996 |
|---|---|
| Medicare specialty | Mental Health Counselor |
Medical group
- Brightside Medical PCBaltimore, MD · 279 clinicians
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