Active NPI
Jacob Long, MED, LPCA, NCC
- Professional Counselor
- Hillsborough, NC
National Provider Identifier
1083161137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- A12428
- Practice address
- 803 US Highway 70a E
Hillsborough, NC 27278-8528 - Phone
- (919) 417-9211
- NPI assigned
- Sep 7, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | A12428 | NC | Primary |
Addresses
Primary practice location
803 US Highway 70a E
Hillsborough, NC 27278-8528
Mailing address
803 US Highway 70a E
Hillsborough, NC 27278-8528
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 5, 2024 through Jan 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A12428 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473206400000",
"number": "1083161137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "803 US HIGHWAY 70A E",
"city": "HILLSBOROUGH",
"state": "NC",
"postal_code": "272788528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "803 US HIGHWAY 70A E",
"city": "HILLSBOROUGH",
"state": "NC",
"postal_code": "272788528",
"telephone_number": "919-417-9211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "JACOB",
"credential": "MED, LPCA, NCC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-07",
"last_updated": "2016-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "A12428",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hillsborough, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.