Active NPI
Jack L McConnell, LCAS
- Addiction (Substance Use Disorder) Counselor
- Hickory, NC
National Provider Identifier
1780888024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1185
- Practice address
- 327 1St Ave NW
Hickory, NC 28601-6122 - Phone
- (828) 695-5900
- Fax
- (828) 695-4256
- NPI assigned
- Jun 12, 2007
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1185 | NC | Primary |
Addresses
Primary practice location
327 1St Ave NW
Hickory, NC 28601-6122
Mailing address
327 1St Ave NW
Hickory, NC 28601-6122
Phone (828) 695-5900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780888024 | Medicaid | NC |
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 |
|---|---|---|---|
| 1185 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440979200000",
"number": "1780888024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "327 1ST AVE NW",
"city": "HICKORY",
"state": "NC",
"postal_code": "286016122",
"telephone_number": "828-695-5900",
"fax_number": "828-695-4256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "327 1ST AVE NW",
"city": "HICKORY",
"state": "NC",
"postal_code": "286016122",
"telephone_number": "828-695-5900",
"fax_number": "828-695-4256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCONNELL",
"first_name": "JACK",
"middle_name": "L",
"credential": "LCAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-12",
"last_updated": "2015-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "1185",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1780888024",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hickory, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.