Benjamin Jared Grossnickle, LCSW-A, LCAS-A
Individual provider Active NPI Clinical Social Worker · Greenville, NC
NPI 1124860705 · NPPES record last updated Jan 30, 2025
Key facts
- NPI
- 1124860705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- C017988 (NC)
- Practice address
- 2602 Courtier Dr
Greenville, NC 27834-7818 - Phone
- (252) 752-0483
- Fax
- (252) 757-3172
- NPI assigned
- Jun 12, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Easter Seals Ucp North Carolina and Virginia, Inc.
Practice addresses (Care Compare)
2602 Courtier Dr
Greenville, NC 27834-7818
Phone (252) 752-0483
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250307003517 | NC | Practitioner - Clinical Social Worker | 3779004601 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-29816 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| C017988 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Easter Seals Ucp North Carolina & Virginia, Inc. | Current |
Accepting new patients | |
| Easter Seals Ucp North Carolina & Virginia, Inc. | Current |
Accepting new patients | |
| Easter Seals Ucp North Carolina & Virginia, Inc. | Current | Accepting new patients |
Locations
2602 Courtier Dr
Greenville, NC 27834
Phone (252) 355-4725
5171 Glenwood Ave
Ste 211
Raleigh, NC 27612
Phone (919) 210-7661
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCAS-29816 | NC | |
| Clinical Social Worker | 1041C0700X | C017988 | NC | Yes |
Addresses
Primary practice location
2602 Courtier Dr
Greenville, NC 27834-7818
Mailing address
2602 Courtier Dr
Greenville, NC 27834-7818
Phone (252) 752-0483
Other providers in Greenville, NC
- Savannah Leigh Gronowski
- Ian Wallace Grooms
- Teresa Gross
- Mauro Grossi
- Sara G Grossi
- Growth Mindset Counseling, PLLC
- Christopher Thomas Grubb
- Jamie S Grubey
- Lillian Gruebel
- GTR Health Services LLC
All providers in Greenville, NC · Clinical Social Worker in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.