Christopher L Jacobson, LCSW
Individual provider Active NPI Clinical Social Worker · Kannapolis, NC
NPI 1194744573 · NPPES record last updated Apr 7, 2016
Key facts
- NPI
- 1194744573
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- C006056 (NC)
- Practice address
- 401 Knollwood Dr
Kannapolis, NC 28083-3633 - Phone
- (704) 754-6883
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Psychological Services of Charlotte
Practice addresses (Care Compare)
1923 J N Pease PL
Suite 204
Charlotte, NC 28262-4535
Phone (704) 503-3535
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 |
|---|---|---|---|---|
| I20190515003243 | NC | Practitioner - Clinical Social Worker | 9638412596 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C006056 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychological Services of Charlotte | Clinical | Current |
Accepting new patients |
Locations
1923 J N Pease Pl
Ste 204
Charlotte, NC 28262
Phone (704) 503-3535
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C006056 | NC | Yes |
Addresses
Primary practice location
401 Knollwood Dr
Kannapolis, NC 28083-3633
Mailing address
401 Knollwood Dr
Kannapolis, NC 28083-3633
Phone (704) 754-6883
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194744573 | Other | NC | PRIVATE PAY |
Other providers in Kannapolis, NC
- Institute for Divine Health
- Instride Foot and Ankle Specialists, PLLC
- Integrated Care, Inc.
- Regina Anne Irving
- Delilah Jerelyn Jackson
- Mary Jasmine
- Danielle McNamara Jenkins
- Jennifer L Wells DDS PA
- Doris Jobe
- John Atkinson, OD, PLLC
All providers in Kannapolis, 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 Apr 7, 2016. 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.