Jacob L Moore, MSW,LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P019400 Issued in NC

Practice address

2550 Court Dr
Gastonia, NC 28054-2152

Phone

(252) 773-0195

Fax

(252) 773-0214

NPI assigned

Jul 19, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1073293684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 LYTTON FARM RD",
            "city": "TROUTMAN",
            "state": "NC",
            "postal_code": "281668663",
            "telephone_number": "704-450-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 COURT DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542152",
            "telephone_number": "252-773-0195",
            "fax_number": "252-773-0214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JACOB",
        "middle_name": "L",
        "credential": "MSW,LCSWA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P019400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Moore
• Charity Ann Moore
• Danielle Moore, RN
• Emily Christine Moore, M.A., CCC-SLP
• Heather Elaine Moore
• Jeremy Scott Moore, MPHA
• Jessica Moore
• Kelly Lynn Moore, LPCA
• Leesha Moore
• Lisa Hamilton Moore, PHARM D

• Clinical Social Worker in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; 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.