Jacob Long, MA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

0704005653 Issued in VA

Practice address

149 Gene Hill Rd
Mount Airy, NC 27030-9072

Phone

(336) 553-8147

NPI assigned

Sep 6, 2022

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

Enrolled in NC, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Vitamind Counseling PLLC

  • Mental Health Counselor
  • Mount Airy, NC
  • NPI 1831895994

  VA

  Medicare reassignment NPD Authorized official
• Long Bridges

  • Peer Specialist
  • Mount Airy, NC
  • NPI 1508671256

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682294400000",
    "number": "1083335285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 GENE HILL RD",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270309072",
            "telephone_number": "336-553-8147",
            "fax_number": "336-464-2376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 GENE HILL RD",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270309072",
            "telephone_number": "336-553-8147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "JACOB",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-06",
        "last_updated": "2023-04-24",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "18420",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0704005653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa America Leyva, MSW, LCSWA
• Lifespan, Inc.
• Emily Lindsey
• Living Waters Prisoner Ministeries
• Long Bridges
• Jose R Lopez, M.D.
• Lovell Medical Supply Inc
• Betty Lovell
• Nicole Grey Lovill
• Mary Lowe, RN

• Mental Health Counselor in Mount Airy, NC
• Providers in Mount Airy, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.