Active NPI
Kathleen Mary Bornarth, LCMHC
- Professional Counselor
- Holly Ridge, NC
National Provider Identifier
1174770721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2488
- Practice address
- 1061 E Ocean Hwy
Holly Ridge, NC 28445-8719 - Phone
- (910) 803-0981
- Fax
- (910) 803-0981
- NPI assigned
- Aug 26, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701004021 | VA | |
| Professional Counselor | 101YP2500X | 2488 | NC | Primary |
Addresses
Primary practice location
1061 E Ocean Hwy
Holly Ridge, NC 28445-8719
Mailing address
814 E Ocean Hwy
Holly Ridge, NC 28445-8714
Phone (910) 803-0981
Other names 1
- Miss Kathleen Mary Bishop
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 |
|---|---|---|---|
| 0701004021 | VA | MD | Professional Counselor |
| 2488 | NC | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588291200000",
"number": "1174770721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 E OCEAN HWY",
"city": "HOLLY RIDGE",
"state": "NC",
"postal_code": "284458714",
"telephone_number": "910-803-0981",
"fax_number": "910-803-0981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1061 E OCEAN HWY",
"city": "HOLLY RIDGE",
"state": "NC",
"postal_code": "284458719",
"telephone_number": "910-803-0981",
"fax_number": "910-803-0981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORNARTH",
"first_name": "KATHLEEN",
"middle_name": "MARY",
"name_prefix": "Mrs.",
"credential": "LCMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-26",
"last_updated": "2020-05-01",
"certification_date": "2020-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701004021",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "2488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KATHLEEN",
"last_name": "BISHOP",
"middle_name": "MARY",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Holly Ridge, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.