Jacobe Leon Douglas, MSA, CCM, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P018932 Issued in NC

Practice address

104 Cone Dr Unit 351
Haw River, NC 27258-9662

Phone

(201) 819-1473

Fax

(336) 217-8532

NPI assigned

Oct 24, 2025

Last updated

Oct 24, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1761264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1649148305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CONE DR UNIT 351",
            "city": "HAW RIVER",
            "state": "NC",
            "postal_code": "272589662",
            "telephone_number": "201-819-1473",
            "fax_number": "336-217-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CONE DR UNIT 351",
            "city": "HAW RIVER",
            "state": "NC",
            "postal_code": "272589662",
            "telephone_number": "201-819-1473",
            "fax_number": "336-217-8532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JACOBE",
        "middle_name": "LEON",
        "name_prefix": "Mr.",
        "credential": "MSA, CCM, LCSWA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-10-24",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P018932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cameron Bryant Gibson, PHARMD
• Haw River Drug Inc (Haw River Discount Drug)
• Haw River Pharmacy LLC (Haw River Pharmacy)
• Jewel Community Care LLC

• Clinical Social Worker in Haw River, NC
• Providers in Haw River, 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 Oct 24, 2025; 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.