Active NPI
Kelly O'Donnell
- Addiction (Substance Use Disorder) Counselor
- Charlotte, NC
National Provider Identifier
1174999635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- LCAS-21515
- Practice address
- 3705 Latrobe Dr
Suite 340
Charlotte, NC 28211-4824 - Phone
- (704) 364-3989
- NPI assigned
- Aug 18, 2015
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCAS-21515 | NC | Primary |
Addresses
Primary practice location
3705 Latrobe Dr
Suite 340
Charlotte, NC 28211-4824
Mailing address
3705 Latrobe Dr
Suite 340
Charlotte, NC 28211-4824
Phone (704) 364-3989
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LCAS-21515 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-21515 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| 12710 | NC | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439856000000",
"number": "1174999635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3705 LATROBE DR",
"address_2": "SUITE 340",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282114824",
"telephone_number": "704-364-3989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3705 LATROBE DR",
"address_2": "SUITE 340",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282114824",
"telephone_number": "704-364-3989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'DONNELL",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-18",
"last_updated": "2015-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "LCAS-21515",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LCAS-21515",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.