Jacobe Leon Douglas, MSA, CCM, LCSWA
Individual provider Active NPI Clinical Social Worker · Haw River, NC
NPI 1649148305 · NPPES record last updated Oct 24, 2025
Key facts
- NPI
- 1649148305
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- P018932 (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
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P018932 | NC | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | P018932 | NC | Yes |
Addresses
Primary practice location
104 Cone Dr Unit 351
Haw River, NC 27258-9662
Mailing address
104 Cone Dr Unit 351
Haw River, NC 27258-9662
Phone (201) 819-1473
Other providers in Haw River, NC
- All God'S Children of Burlington, LLC
- Eboni Allen
- Kathleen Marie Anderson
- Mary Christopher
- Brandy Michelle Faucette
- Cameron Bryant Gibson
- Haw River Drug Inc
- Haw River Pharmacy LLC
- Jewel Community Care LLC
All providers in Haw River, NC · Clinical Social Worker in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.