Jack L Ellerbe Jr., MSW, LCAS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

665 Timber TRL
Gold Hill, NC 28071-7500

Phone

(704) 279-1199

Fax

(704) 279-7668

NPI assigned

Jul 15, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Timber Ridge Treatment Center, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Gold Hill, NC
  • NPI 1609852201
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1073185245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 259",
            "city": "GOLD HILL",
            "state": "NC",
            "postal_code": "280710259",
            "telephone_number": "704-279-1199",
            "fax_number": "704-279-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 TIMBER TRL",
            "city": "GOLD HILL",
            "state": "NC",
            "postal_code": "280717500",
            "telephone_number": "704-279-1199",
            "fax_number": "704-279-7668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 W Dallas Rd",
            "address_purpose": "LOCATION",
            "city": "Stanley",
            "state": "NC",
            "postal_code": "281642103",
            "country_code": "US",
            "telephone_number": "980-416-3025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLERBE",
        "first_name": "JACK",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MSW, LCAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-15",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Christine Chepke, LCSW
• Jason Cline, ATC
• Starla Daniel
• Thomas A Hibbert, MA
• William Donovan Miller, LCSWA
• Oak & Ember Counseling
• Gregory Francis Pozzi, MED., LPC
• Charles Lewis Sattenfield

• Addiction (Substance Use Disorder) Counselor in Gold Hill, NC
• Providers in Gold Hill, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.