Individual provider Active NPI

Jarrell Stephen McQueen, MSW, LCAS-A

  • Addiction (Substance Use Disorder) Counselor
  • Wilmington, NC
National Provider Identifier
1457027484
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
LCAS-27427 Issued in NC
Practice address
917 N 4TH St
Wilmington, NC 28401-3450
Phone
(910) 202-8656
Fax
(910) 202-8680
NPI assigned
Aug 19, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LCAS-27427 NC Primary

Addresses

Primary practice location

917 N 4TH St
Wilmington, NC 28401-3450

Mailing address

925 N 4TH St
Wilmington, NC 28401-3450
Phone (910) 202-8655

Other practice location 1

925 N 4th St
Wilmington, NC 28401-3450
Phone (910) 343-0270

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20240813002381 NC Practitioner - Clinical Social Worker 0840738563 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Hanover Community Health Center IncorporatedGroup PAC ID 1153220215, 24 clinicians

Practice addresses (Care Compare)

925 N 4TH St
Wilmington, NC 28401-3450

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCAS-27427NCMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
New Hanover Community Health Center Incorporated CurrentSince Apr 14, 2024 Accepting new patients
New Hanover Community Health Center Incorporated CurrentSince Apr 14, 2024 Accepting new patients

Locations

925 N 4th St
Wilmington, NC 28401
Phone (910) 254-4690

240 Calhoun Dr
Wilmington, NC 28412
Phone (910) 202-8656

917 N 4th St
Wilmington, NC 28401
Phone (910) 202-8656

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1457027484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 N 4TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284013450",
            "telephone_number": "910-202-8655",
            "fax_number": "910-251-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 N 4TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284013450",
            "telephone_number": "910-202-8656",
            "fax_number": "910-202-8680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "925 N 4th St",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284013450",
            "country_code": "US",
            "telephone_number": "910-343-0270",
            "fax_number": "910-251-1540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCQUEEN",
        "first_name": "JARRELL",
        "middle_name": "STEPHEN",
        "credential": "MSW, LCAS-A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-27427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.