Individual provider Active NPI

Janice Lakesha McGilberry

  • Psychologist
  • Durham, NC
National Provider Identifier
1104110162
Registry record updated Apr 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
5024 Issued in NC
Practice address
1802 Martin Luther King Pkwy Ste 107
Durham, NC 27707-3586
Phone
(919) 908-9308
Fax
(919) 287-2206
NPI assigned
Jun 7, 2011
Last updated
Apr 3, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 8708 NC
Psychologist 103T00000X 5024 NC Primary

Addresses

Primary practice location

1802 Martin Luther King Pkwy Ste 107
Durham, NC 27707-3586

Mailing address

4 Mulberry CT
Durham, NC 27713-4521
Phone (919) 908-9308

Other practice location 1

511 S McMorrine St
Elizabeth City, NC 27909-4905
Phone (919) 908-9308

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

State licenses

LicenseStateTypeSpecialty
8708NCMDCounselor
5024NCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Connect Center for Wellness CurrentSince Apr 5, 2020 Accepting new patients

Locations

1802 Martin Luther King Pkwy
Ste 107
Durham, NC 27707
Phone (919) 401-5061

511 S McMorrine St
Elizabeth City, NC 27909
Phone (919) 908-9308

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": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585872000000",
    "number": "1104110162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MULBERRY CT",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277134521",
            "telephone_number": "919-908-9308",
            "fax_number": "919-287-2206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 MARTIN LUTHER KING PKWY STE 107",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277073586",
            "telephone_number": "919-908-9308",
            "fax_number": "919-287-2206"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "511 S McMorrine St",
            "address_purpose": "LOCATION",
            "city": "Elizabeth City",
            "state": "NC",
            "postal_code": "279094905",
            "country_code": "US",
            "telephone_number": "919-908-9308",
            "fax_number": "919-287-2206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCGILBERRY",
        "first_name": "JANICE",
        "middle_name": "LAKESHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-07",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "8708",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "5024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; 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.