Provider Demographics
NPI:1295378941
Name:JACKSON, ADRIAKA Y (MS)
Entity Type:Individual
Prefix:
First Name:ADRIAKA
Middle Name:Y
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ADRIAKA
Other - Middle Name:Y
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:5868 E 71ST ST STE E-630
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4075
Mailing Address - Country:US
Mailing Address - Phone:317-835-3435
Mailing Address - Fax:
Practice Address - Street 1:5868 E 71ST ST STE E-630
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4075
Practice Address - Country:US
Practice Address - Phone:317-835-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99092140A101YA0400X
IN39004508A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8973191013Other8973191013