Individual provider Active NPI

Keren Happuch Williams, LCMHC

  • Mental Health Counselor
  • Winston Salem, NC
National Provider Identifier
1003163213
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
10911 Issued in NC
Practice address
140 Kimel Park Dr Ste 200
Winston Salem, NC 27103-6185
Phone
(336) 718-7250
Fax
(336) 718-7260
NPI assigned
Aug 7, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 10911 NC
Addiction (Substance Use Disorder) Counselor 101YA0400X 20281 NC
Mental Health Counselor 101YM0800X 10911 NC Primary

Addresses

Primary practice location

140 Kimel Park Dr Ste 200
Winston Salem, NC 27103-6185

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

820 Grimes Blvd
Lexington, NC 27292-7640
Phone (866) 272-7826

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240215000104 NC Practitioner - Mental Health Counselor 9032553383 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

13815 Professional Ctr Dr
Suite 300
Huntersville, NC 28078-7950
Phone (704) 384-6225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20281NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Jan 6, 2024 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jan 6, 2024 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Jan 6, 2024 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Jan 6, 2024 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients

Locations

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

13815 Professional Center Dr
Ste 100
Huntersville, NC 28078
Phone (704) 316-2050

13815 Professional Center Dr
#300
Huntersville, NC 28078
Phone (704) 384-6225

280 Broad St
Ste E
Kernersville, NC 27284
Phone (336) 277-6050

6620 Shallowford Rd
#200
Lewisville, NC 27023
Phone (336) 757-0258

309 Pineywood Rd
Thomasville, NC 27360
Phone (336) 474-8921

140 Kimel Park Dr
Ste 101
Winston Salem, NC 27103
Phone (336) 718-7280

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

175 Kimel Park Dr
Ste 100
Winston Salem, NC 27103
Phone (336) 277-1811

140 Kimel Park Dr
Ste 200
Winston Salem, NC 27103
Phone (336) 718-7250

Networks

  • devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1
  • devoted network organization-0f7f8d4f-1035-4992-8c02-dc86d12e700e
  • devoted network organization-84bf27aa-506a-49c4-8818-702cf5e8efb3
  • TN PPO
  • TN PPO C-SNP

Interoperability endpoints

  • Direct secure messaging: kwilliams1303634@direct.novanthealth.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1003163213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 KIMEL PARK DR STE 200",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036185",
            "telephone_number": "336-718-7250",
            "fax_number": "336-718-7260"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 Grimes Blvd",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "NC",
            "postal_code": "272927640",
            "country_code": "US",
            "telephone_number": "866-272-7826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KEREN",
        "middle_name": "HAPPUCH",
        "credential": "LCMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-07",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "10911",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "20281",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "10911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.