Jessie Ray Staton, LCAS, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C007929 Issued in NC

Practice address

144 Community College Rd
Suite B
Ahoskie, NC 27910-8047

Phone

(252) 209-8932

Fax

(252) 332-2483

NPI assigned

Nov 29, 2010

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1290988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475107200000",
    "number": "1487956397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300-110 SAPPHIRE CT",
            "address_2": "PORT HUMAN SERVICES",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "27834",
            "telephone_number": "252-830-7540",
            "fax_number": "252-752-0074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 COMMUNITY COLLEGE RD",
            "address_2": "SUITE B",
            "city": "AHOSKIE",
            "state": "NC",
            "postal_code": "279108047",
            "telephone_number": "252-209-8932",
            "fax_number": "252-332-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATON",
        "first_name": "JESSIE",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "LCAS, LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-29",
        "last_updated": "2016-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1727",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C007929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6112245",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Ahoskie, NC
• Providers in Ahoskie, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.