Active NPI
Stephanie Puckett, LPCA
- Professional Counselor
- Mount Airy, NC
National Provider Identifier
1114328077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- A11005
- Practice address
- 414 W Lebanon St
Mount Airy, NC 27030-2954 - Phone
- (336) 789-9492
- Fax
- (336) 789-9587
- NPI assigned
- Sep 10, 2014
- Sex
- Female
- 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 | A11005 | NC | Primary |
Addresses
Primary practice location
414 W Lebanon St
Mount Airy, NC 27030-2954
Mailing address
414 W Lebanon St
Mount Airy, NC 27030-2954
Phone (336) 789-9492
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
| License | State | Type | Specialty |
|---|---|---|---|
| A11005 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410307200000",
"number": "1114328077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "414 W LEBANON ST",
"city": "MOUNT AIRY",
"state": "NC",
"postal_code": "270302954",
"telephone_number": "336-789-9492",
"fax_number": "336-789-9587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 W LEBANON ST",
"city": "MOUNT AIRY",
"state": "NC",
"postal_code": "270302954",
"telephone_number": "336-789-9492",
"fax_number": "336-789-9587"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "STEPHANIE",
"credential": "LPCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-10",
"last_updated": "2014-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "A11005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Airy, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.