Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jon D Weddell, LCSWA

Individual provider Clinical Social Worker · NPI 1154048130

Jon D Weddell, LCSWA is a Clinical Social Worker in Charlotte, North Carolina. Qualified in 2021, 5 years ago. Practices with Carolina Outreach, LLC, a 17-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
5
Licensed in
NC
In the registry since
2022
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Practice location Address checks out

5108 Reagan Dr Ste 14
Charlotte, NC 28206-1395
Phone: (704) 332-8787
Fax: (704) 332-8788
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence P017404 (NC)

Record details

NPI number1154048130
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSWA
Sole proprietorNo
NPI enumeratedOctober 20, 2022
Last updated in NPPESOctober 20, 2022
Certification dateOctober 20, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Carolina Outreach, Llc — 17 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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