JACOB AVERILL (NPI# 1659930618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659930618 |
| Entity Type | Individual |
| Full Name | JACOB AVERILL |
| Credential | MSW |
| Practice Address |
309 Progress Drive Burgaw NC 28425-5001 |
| Mailing Address |
2304 Sir Morris Ct Greenville NC 27858-9429 |
| Practice Telephone | 9102590668 |
| Mailing Telephone | 2523416332 |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2019-07-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
25590 | NC | Behavioral Health & Social Service Providers |
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Street Address |
309 PROGRESS DRIVE |
| City | BURGAW |
| State | NC |
| Zip Code | 28425-5001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982863247 | Monique Cecillia Boyd | Social Worker | 309 Progress Drive, Burgaw, NC 28425 | 2008-06-03 |
| 1902462930 | Marjorie Justice | Social Worker | 309 Progress Drive, Burgaw, NC 28425-5001 | 2019-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861091662 | Chiquitta Williams Lesene | Counselor | 407 E Fremont Street, Burgaw, NC 28425 | 2020-10-22 |
| 1255978912 | David L Populus Jr. | Preventive Medicine | 1638 Hwy 53, Burgaw, NC 28425 | 2019-12-02 |
| 1467948729 | Coastal Horizons Center Inc. | Community/Behavioral Health | 309 Progress Dr., Burgaw, NC 28425 | 2018-07-10 |
| 1629504824 | Kellie Savard | Speech-Language Pathologist | 213 South Wright Street, Unit B, Burgaw, NC 28425 | 2017-05-08 |
| 1578004800 | Alisa Fussell | Speech-Language Pathologist | 10131 Highway 53 W, Burgaw, NC 28425 | 2017-03-20 |
| 1881136851 | Pender Pediatric Therapy, PC | Speech-Language Pathologist | 126 W. Fremont St., Burgaw, NC 28425 | 2016-11-08 |
| 1821424771 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 206 Us Highway 117 S, Burgaw, NC 28425 | 2013-09-24 |
| 1679816193 | Kerry Dawn Daraskavich | Physical Therapist | 311 South Campell Street, Burgaw, NC 28425 | 2013-04-03 |
| 1184985178 | Kerr Drug | Point of Service | 206 Us Route 117 South, Burgaw, NC 28425 | 2012-06-06 |
| 1407117682 | Courtney L Gibbs | Speech-Language Pathologist | 126 W Fremont St, Burgaw, NC 28425 | 2012-06-04 |
| Find all providers in zip 28425 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285971325 | Arlene Marie Mulholland | Social Worker | 16972 Us Highway 421, Burgaw, NC 28425-2572 | 2013-01-09 |
| 1982863247 | Monique Cecillia Boyd | Social Worker | 309 Progress Drive, Burgaw, NC 28425 | 2008-06-03 |
| 1043838055 | Holly Mckoy | Social Worker | 309 Progress Dr, Burgaw, NC 28425-3280 | 2020-07-07 |
| 1033762224 | Macy Leigh Baynor | Social Worker | 309 Progress Dr, Burgaw, NC 28425-3280 | 2019-07-17 |
| 1902462930 | Marjorie Justice | Social Worker | 309 Progress Drive, Burgaw, NC 28425-5001 | 2019-05-15 |
| 1306332234 | Kelly Marie Berry | Social Worker | 803 S Walker St, Burgaw, NC 28425-5001 | 2018-07-03 |
| 1043714652 | Regan Margaret Springs | Social Worker | 803 S Walker St, Burgaw, NC 28425-5001 | 2018-03-19 |
| 1114447430 | Laura Theresa O'connor | Social Worker | 309 Progress Dr, Burgaw, NC 28425-3280 | 2017-06-27 |
| 1922559632 | Anna Elizabeth Miller | Social Worker | 803 S Walker St, Burgaw, NC 28425-5001 | 2016-10-18 |
| 1831591239 | Judith Knisely | Social Worker | 803 S Walker St, Burgaw, NC 28425-5001 | 2014-09-17 |
| Find all providers in BURGAW | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.