Individual provider Active NPI

Kathleen Amanda Cherry, LCMHC

  • Professional Counselor
  • Charlotte, NC
National Provider Identifier
1063753374
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
7401 Carmel Executive Park Dr Ste 210
Charlotte, NC 28226-0406
Phone
(704) 752-8414
Fax
(704) 544-1109
NPI assigned
Mar 12, 2013
Last updated
Jan 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X 9612 NC
Addiction (Substance Use Disorder) Counselor 101YA0400X
Professional Counselor 101YP2500X Primary

Addresses

Primary practice location

7401 Carmel Executive Park Dr Ste 210
Charlotte, NC 28226-0406

Mailing address

7401 Carmel Executive Park Dr Ste 210
Charlotte, NC 28226-0406
Phone (704) 752-8414

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Yes, effective Jul 18, 2024 through Jul 18, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9612NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Counseling Group of Charlotte, Inc. Professional PastSince Jan 29, 2023 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1063753374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7401 CARMEL EXECUTIVE PARK DR STE 210",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282260406",
            "telephone_number": "704-752-8414",
            "fax_number": "704-544-1109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7401 CARMEL EXECUTIVE PARK DR STE 210",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282260406",
            "telephone_number": "704-752-8414",
            "fax_number": "704-544-1109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHERRY",
        "first_name": "KATHLEEN",
        "middle_name": "AMANDA",
        "credential": "LCMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-12",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "NC",
            "license": "9612",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.