Active NPI
Jaime Reyes Gonzalez, MA
- Professional Counselor
- Fayetteville, NC
National Provider Identifier
1063715217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 8049
- Practice address
- 114 Highland Ave
Fayetteville, NC 28305-5306 - Phone
- (910) 484-0176
- Fax
- (910) 484-5781
- NPI assigned
- Dec 9, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 8049 | NC | Primary |
Addresses
Primary practice location
114 Highland Ave
Fayetteville, NC 28305-5306
Mailing address
114 Highland Ave
Fayetteville, NC 28305-5306
Phone (910) 484-0176
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8049 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364515200000",
"number": "1063715217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 HIGHLAND AVE",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283055306",
"telephone_number": "910-484-0176",
"fax_number": "910-484-5781"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 HIGHLAND AVE",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283055306",
"telephone_number": "910-484-0176",
"fax_number": "910-484-5781"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYES GONZALEZ",
"first_name": "JAIME",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-12-09",
"last_updated": "2013-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "8049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.