Individual provider · Type 1 NPI

Angela Decarla Jackson, PhD, LCPC, LMHC

Professional Counselor · South Bend, IN

NPI number 1194267476 Active

Practice location

1251 N Eddy St Ste 200
South Bend, IN 46617-1478

Call (312) 798-9755 Map

Other practice locations

  • 1251 N Eddy St Ste 200, South Bend, IN 46617-1478 · (312) 798-9755

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor 101YP2500X180.011258 (IL)
Professional Counselor Primary 101YP2500X39004648A (IN)

Professional Counselor: Definition to come...

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About NPI 1194267476

Angela Decarla Jackson, PhD, LCPC, LMHC's National Provider Identifier is 1194267476, issued on Nov 17, 2016. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in South Bend, IN. The record was last updated on Jun 25, 2025.