Patrick Sal Ide, MA, LPCA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1922 S Martin Luther King Jr Dr Ste 255
Winston Salem, NC 27107-1361

Phone

(336) 464-3136

NPI assigned

Feb 7, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1174022966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12884 S FRONTRUNNER BLVD STE 140",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205488",
            "telephone_number": "336-423-7697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1922 S MARTIN LUTHER KING JR DR STE 255",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271071361",
            "telephone_number": "336-464-3136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDE",
        "first_name": "PATRICK",
        "middle_name": "SAL",
        "credential": "MA, LPCA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-02-07",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912446253",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.