NPIMap

Organization Active NPI

Anchor Psychological & Counseling Services PLLC

  • Clinical Psychologist
  • Hampstead, NC
National Provider Identifier
1114124401
Registry record updated Jul 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2335 Issued in NC
Legal business name
ANCHOR PSYCHOLOGICAL & COUNSELING SERVICES PLLC
Practice address
16581 US Hwy 17 N
Suite 600
Hampstead, NC 28443-7451
Phone
(910) 270-9995
Fax
(910) 270-9905
NPI assigned
Jun 29, 2007
Last updated
Jul 31, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2012

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

Authorized official

Name
Mrs. Mary M Godin, MA, LPC LPANPI 1962488403
Title
Owner
Phone
(910) 270-9995

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 4801 NC
Cognitive & Behavioral Psychologist 103TB0200X 2335 NC
Clinical Psychologist 103TC0700X 2335 NC Primary

Addresses

Primary practice location

16581 US Hwy 17 N
Suite 600
Hampstead, NC 28443-7451

Mailing address

16581 US Hwy 17 N
Suite 600
Hampstead, NC 28443-7451
Phone (910) 270-9995

Other identifiers 1

IdentifierTypeStateIssuer
6006154MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100519000477 NC Part B Supplier - Clinic/Group Practice 7517096290 Receives reassigned benefits from 18 practitioners
Practice locations: Hampstead, NC; Wilmington, NC

National Provider Directory

National Provider Directory

Locations

16581 US Highway 17
Ste 600
Hampstead, NC 28443
Phone (910) 270-9995

1442 Military Cutoff Rd
Unit B
Wilmington, NC 28403
Phone (252) 822-4150

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343692800000",
    "number": "1114124401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16581 US HWY 17 N",
            "address_2": "SUITE 600",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284437451",
            "telephone_number": "910-270-9995",
            "fax_number": "910-270-9905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16581 US HWY 17 N",
            "address_2": "SUITE 600",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284437451",
            "telephone_number": "910-270-9995",
            "fax_number": "910-270-9905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANCHOR PSYCHOLOGICAL & COUNSELING SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-29",
        "last_updated": "2012-07-31",
        "status": "A",
        "authorized_official_last_name": "GODIN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-270-9995",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LPC LPA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "4801",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NC",
            "license": "2335",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "2335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006154",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampstead, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.