Jacqueline Renee Worthington, LCMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11219 Issued in NC

Practice address

217 Aqua Marine LN
Knightdale, NC 27545-7869

Phone

(919) 667-4583

NPI assigned

Feb 13, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1423785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1013308964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 AQUA MARINE LN",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275457869",
            "telephone_number": "919-667-4583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 AQUA MARINE LN",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275457869",
            "telephone_number": "919-667-4583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3500 Westgate Dr",
            "address_2": "101",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277072567",
            "country_code": "US",
            "telephone_number": "919-667-4583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WORTHINGTON",
        "first_name": "JACQUELINE",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "LCMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-13",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "11219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Knightdale, NC
• Providers in Knightdale, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.