William Thomas Gordon Etheridge

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

15542 Issued in NC

Practice address

Thriveworks
8406 Six Forks Rd Suite 104
Raleigh, NC 27615

Phone

(919) 642-4857

NPI assigned

Jan 22, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Thriveworks Clinical - North Carolina PCGroup PAC ID 8527471200, 109 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thriveworks Clinical - North Carolina PC

  • Mental Health Counselor
  • Raleigh, NC
  • NPI 1003303082
  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  NC

  Medicare reassignment NPD

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

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1205466885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 MASONDALE AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277073152",
            "telephone_number": "919-308-7306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "THRIVEWORKS",
            "address_2": "8406 SIX FORKS RD SUITE 104",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27615",
            "telephone_number": "919-642-4857"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "122 Masondale Ave",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277073152",
            "country_code": "US",
            "telephone_number": "919-308-7306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "WILLIAM",
        "middle_name": "THOMAS GORDON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-22",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "15542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaye Estrada
• Estrella Rehabilitation and Support Services Inc
• Ethan R. Levine, PH.D.
• Terry Ether, C.P.O.
• Amelia Etheridge
• Erica Etienne
• Nicanor Etienne
• Stefanie Linette Etienne, MD
• Etta'S Residential Services and Supports, Inc.
• Halima Ettalbi

• Mental Health Counselor in Raleigh, NC
• Providers in Raleigh, 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 Sep 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.