Active NPI
Jacob Samuel Davis, MSW, LCSWA
- Clinical Social Worker
- Monroe, NC
National Provider Identifier
1508695842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P020630
- Practice address
- 701 E Roosevelt Blvd Ste 600
Monroe, NC 28112-4106 - Phone
- (704) 296-6200
- NPI assigned
- Jul 26, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | P020630 | NC | Primary |
Addresses
Primary practice location
701 E Roosevelt Blvd Ste 600
Monroe, NC 28112-4106
Mailing address
284 Executive Park Dr
Concord, NC 28025-1831
Phone (704) 939-1100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P020630 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Daymark Recovery Services, Inc. | Clinical | Past | Accepting new patients |
Interoperability endpoints
- jacob.davis.p1@direct.daymarkrecovery.nextgenshare.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723507200000",
"number": "1508695842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "284 EXECUTIVE PARK DR",
"city": "CONCORD",
"state": "NC",
"postal_code": "280251831",
"telephone_number": "704-939-1100",
"fax_number": "704-939-1173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 E ROOSEVELT BLVD STE 600",
"city": "MONROE",
"state": "NC",
"postal_code": "281124106",
"telephone_number": "704-296-6200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JACOB",
"middle_name": "SAMUEL",
"credential": "MSW, LCSWA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-26",
"last_updated": "2024-08-13",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P020630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.