Mark Jacob, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1081C Issued in AL

Practice address

251 Johnston St SE Ste 100
Decatur, AL 35601-2515

Phone

(256) 822-2375

NPI assigned

May 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

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 1

Specialty

Clinical Social Worker

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Covenant Counseling and Consulting LLCGroup PAC ID 2769789551, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Covenant Counseling & Consulting LLC

  • Professional Counselor
  • Decatur, AL
  • NPI 1295111557
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1245285295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 MOULTON ST E",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356012310",
            "telephone_number": "256-822-2375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 JOHNSTON ST SE STE 100",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356012515",
            "telephone_number": "256-822-2375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "MARK",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "1081C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51522567",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antwain Jackson
• Kirk Lee Jackson, M.D.
• Porsha Jackson, ALC
• Stacey N Jackson, L.C.S.W. P.I.P
• Christy Flannagin Jacob, M.S., LPC, NCC, BCC
• Jasmine Keamber Jacobs, CRNP
• Jessie K Jacobs, LICSW
• Chanel M Jahn, BS
• Brian Ray James, M.D.
• John Nicolas James

• Clinical Social Worker in Decatur, AL
• Providers in Decatur, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.