; NPI #1164264719

Contact Information

TISHA C JACOBS, LCSWA

7489 ROCKFISH RD
RAEFORD, NC 28376-6131

Phone: 910-584-6739
Fax: 833-260-0543
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Student Health	261QS1000X
Clinical	1041C0700X	80	Licensed Clinical Social Worker

Indicates primary specialty

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NPI Profile & details for

NPI Number 1164264719

Entity Organization

Organization subpart ¹ Not specified

Enumeration date 06/12/2024

Last updated 05/21/2026 - About 3 weeks ago

Identifiers

License #

P022526

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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