Jacobe Leon Douglas, MSA, CCM, LCSWA
Social Worker, Clinical in Haw River, NC. Individual provider (NPI-1).
NPI number1649148305
StatusActive
Last updated in NPPESOct 24, 2025
Details
- NPI
- 1649148305
- Entity type
- Individual (NPI-1)
- Name
- Mr. Jacobe Leon Douglas
- Credential
- MSA, CCM, LCSWA
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 24, 2025
- Certification date
- Oct 24, 2025
- Last updated
- Oct 24, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | P018932 | NC | Yes |
Practice location
104 Cone Dr Unit 351Haw River, NC 27258-9662
Phone 201-819-1473 · Fax 336-217-8532
Mailing address
104 Cone Dr Unit 351Haw River, NC 27258-9662
Phone 201-819-1473 · Fax 336-217-8532
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