Healthcare Provider Details

I. General information

NPI: 1689581415
Provider Name (Legal Business Name): JACOB REID HIX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 W 4TH ST
WINSTON SALEM NC
27101-2582
US

IV. Provider business mailing address

PO BOX 97
WELCOME NC
27374-0097
US

V. Phone/Fax

Practice location:
  • Phone: 336-747-3031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23141
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: