Individual provider Active NPI

Carissa Renee Brown, MA, LCMHCS

  • Professional Counselor
  • Siler City, NC
National Provider Identifier
1174860324
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
9147 Issued in NC
Practice address
1105 E Cardinal St
Siler City, NC 27344-3300
Phone
(919) 663-2955
Fax
(919) 799-7713
NPI assigned
Jan 8, 2013
Last updated
Jun 28, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 9147 NC Primary

Addresses

Primary practice location

1105 E Cardinal St
Siler City, NC 27344-3300

Mailing address

284 Executive Park Dr Ste 100
Concord, NC 28025-1833
Phone (704) 939-1100

Other identifiers 4

IdentifierTypeStateIssuer
601121-450OtherNCMAGELLAN
1174860324OtherNCHUMANA
19H2HOtherNCBCBS
1174860324MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240322002890 NC Practitioner - Mental Health Counselor 2567809718 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Daymark Recovery Services IncGroup PAC ID 0547233975, 132 clinicians

Practice addresses (Care Compare)

1105 E Cardinal St
Siler City, NC 27344-3300
Phone (919) 663-2955

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
9147NCMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Daymark Recovery Services, Inc. Professional CurrentSince Jan 28, 2024 Accepting new patients

Locations

284 Executive Park Dr
Ste 100
Kannapolis, NC 28025
Phone (704) 939-1118

1104A S Main St
Lexington, NC 27292
Phone (336) 300-8836

2129 Statesville Blvd
Salisbury, NC 28147
Phone (704) 633-3616

1105 E Cardinal St
Siler City, NC 27344
Phone (919) 663-2127

227 N Main St
Troy, NC 27371
Phone (910) 572-3681

Interoperability endpoints

  • Direct secure messaging: carissa.brown.p1@direct.daymarkrecovery.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1357603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1174860324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DR STE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251833",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 E CARDINAL ST",
            "city": "SILER CITY",
            "state": "NC",
            "postal_code": "273443300",
            "telephone_number": "919-663-2955",
            "fax_number": "919-799-7713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "CARISSA",
        "middle_name": "RENEE",
        "credential": "MA, LCMHCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-08",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "9147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "601121-450",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "1174860324",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "19H2H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174860324",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Siler City, NC

Sources for this page

Verify at the official NPI Registry.