Carla Jack, LCSW in Decatur, GA - Medicare Counselor Provider

Carla Jack, LCSW is a medicare enrolled "Counselor - Mental Health" provider in Decatur, Georgia. Her current practice location is 4151 Memorial Dr Ste 209c, Decatur, Georgia. You can reach out to her office (for appointments etc.) via phone at (404) 508-0078.

Carla Jack is licensed to practice in Georgia (license number CSW006674) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1992306989.

Contact Information

	Carla Jack, LCSW
	4151 Memorial Dr Ste 209c, Decatur, GA 30032-1597
	(404) 508-0078
	(404) 508-0071

Map and Direction

Healthcare Provider's Profile

Full Name	Carla Jack
Gender	Female
Speciality	Counselor - Mental Health
Location	4151 Memorial Dr Ste 209c, Decatur, Georgia
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1992306989
Provider Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020

Medicare PECOS Information:

PECOS PAC ID: 4486043510
Enrollment ID: I20211111001231

Medical Identifiers

Medical identifiers for Carla Jack such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1992306989	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
101YM0800X	Counselor - Mental Health	CSW006674 (Georgia)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Carla Jack allows following entities to bill medicare on her behalf.

Entity Name	Assertive Community Recovery, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1265607683 PECOS PAC ID: 6709055817 Enrollment ID: O20140306001781

Entity Name	Breakthrough Recovery Outreach Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1982909503 PECOS PAC ID: 7012139363 Enrollment ID: O20210312001617

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Carla Jack is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Carla Jack, LCSW 4151 Memorial Dr Ste 209c, Decatur, GA 30032-1597 Ph: (404) 508-0078	Carla Jack, LCSW 4151 Memorial Dr Ste 209c, Decatur, GA 30032-1597 Ph: (404) 508-0078

Reviews and Comments

Counselor in Decatur, GA

Robin C Johnson, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 3523 Moonlight Forest Ct, Decatur, GA 30034 Phone: 770-374-1605
Shaina Gordon, Counselor Medicare: Not Enrolled in Medicare Practice Location: 465 Winn Way, 221, Decatur, GA 30030 Phone: 404-292-3810
Sarah Davison, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 445 Winn Way, Decatur, GA 30030 Phone: 404-294-3836
Giselle Amaris Jacob, MS Counselor Medicare: Not Enrolled in Medicare Practice Location: 1244 Clairmont Rd Ste 204, Decatur, GA 30030 Phone: 404-818-6535
Mrs. Anna Christina Davis, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 465 Winn Way, Suite 221, Decatur, GA 30030 Phone: 404-292-3810 Fax: 404-292-3848
Jacob Dreiling, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1814 Clairmont Rd, Decatur, GA 30033 Phone: 404-636-1457 Fax: 404-636-7449
Nathaniel Flowers, Counselor Medicare: Not Enrolled in Medicare Practice Location: 3232 Memorial Dr, Decatur, GA 30032 Phone: 678-235-5478

Carla Jack, LCSW - Medicare Counselor in Decatur, GA