Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Angela Decarla Jackson, PHD, LCPC, LMHC

Individual provider Professional Counselor · NPI 1194267476

Dr. Angela Decarla Jackson, PHD, LCPC, LMHC is a Mental Health Counselor in South Bend, Indiana. Qualified in 2004, 22 years ago. Works from 2 locations. Licensed in Illinois and Indiana.

Years since qualifying
22
Licensed in
IL, IN
In the registry since
2016
Specialties on file
2
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.
LCPC — Licensed Clinical Professional Counselor
A licensed clinical counsellor.
LMHC — Licensed Mental Health Counselor
A licensed mental health counsellor; the title used in Florida, New York and Washington among others.

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Practice location Address checks out

1251 N Eddy St Ste 200
South Bend, IN 46617-1478
Phone: (312) 798-9755
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

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

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 39004648A (IN)
Professional Counselor Taxonomy 101YP2500X · Licence 180.011258 (IL)

Record details

NPI number1194267476
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHD , LCPC , LMHC
Sole proprietorNo
NPI enumeratedNovember 17, 2016
Last updated in NPPESJune 25, 2025
Certification dateJune 25, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Accepts Medicare assignment Not indicated

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