Amanda Elizabeth Gentry – Professional Counselor

Key facts

NPI: 1114040490
Entity type: Individual (NPI type 1)
Primary specialty: Professional Counselor 101YP2500X
License: 3369 (NC)
Practice address: 224 North Main Street
Jefferson, NC 28640
Phone: (336) 846-7492
Fax: (336) 846-7397
NPI assigned: Apr 9, 2007
Sex: Female
Sole proprietor: No

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 and National Provider Directory roles.

Crossroads Counseling Services Mental Health Counselor · Jefferson, NC · NPI 1932168689

NPD (past) Authorized official

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
3369	NC	MD	School Psychologist

Practice roles

Organization	Specialty	Status	New patients
Crossroads Counseling Services		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Professional Counselor	101YP2500X	3369	NC	Yes

Addresses

Primary practice location

224 North Main Street
Jefferson, NC 28640

Mailing address

PO Box 212
Jefferson, NC 28640-0212
Phone (336) 846-7492

Other identifiers

Identifier	Type	State	Issuer
6102328	Medicaid	NC
1226J	Other	NC	BLUECROSS AND BLUESHIELD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114040490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 212",
            "city": "JEFFERSON",
            "state": "NC",
            "postal_code": "286400212",
            "telephone_number": "336-846-7492",
            "fax_number": "336-846-7397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 NORTH MAIN STREET",
            "city": "JEFFERSON",
            "state": "NC",
            "postal_code": "28640",
            "telephone_number": "336-846-7492",
            "fax_number": "336-846-7397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENTRY",
        "first_name": "AMANDA",
        "middle_name": "ELIZABETH",
        "credential": "L.P.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "3369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6102328",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS AND BLUESHIELD",
            "identifier": "1226J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, NC

All providers in Jefferson, NC · Professional Counselor in North Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.