Active NPI
Kelsey Crist, LCMHCA, CCS, LCAS
- Professional Counselor
- Shallotte, NC
National Provider Identifier
1225729957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- A14201
- Practice address
- 120 Coastal Horizons Dr
Shallotte, NC 28470-6094 - Phone
- (910) 758-4451
- NPI assigned
- May 15, 2023
- Last updated
- May 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 24385 | NC | |
| Mental Health Counselor | 101YM0800X | A14201 | NC | |
| Professional Counselor | 101YP2500X | A14201 | NC | Primary |
Addresses
Primary practice location
120 Coastal Horizons Dr
Shallotte, NC 28470-6094
Mailing address
615 Shipyard Blvd
Wilmington, NC 28412-6431
Other practice location 1
615 Shipyard Blvd
Wilmington, NC 28412-6431
Phone (910) 343-0145
Other practice location 2
6 Doctors Cir Ste 1
Supply, NC 28462-6358
Phone (910) 754-4233
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 |
|---|---|---|---|
| 24385 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| A14201 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684800000000",
"number": "1225729957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 SHIPYARD BLVD",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284126431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 COASTAL HORIZONS DR",
"city": "SHALLOTTE",
"state": "NC",
"postal_code": "284706094",
"telephone_number": "910-758-4451"
}
],
"practiceLocations": [
{
"address_1": "615 Shipyard Blvd",
"address_purpose": "LOCATION",
"city": "Wilmington",
"state": "NC",
"postal_code": "284126431",
"country_code": "US",
"telephone_number": "910-343-0145",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6 Doctors Cir Ste 1",
"address_purpose": "LOCATION",
"city": "Supply",
"state": "NC",
"postal_code": "284626358",
"country_code": "US",
"telephone_number": "910-754-4233",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CRIST",
"first_name": "KELSEY",
"credential": "LCMHCA, CCS, LCAS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-15",
"last_updated": "2023-05-23",
"certification_date": "2023-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "24385",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "A14201",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "A14201",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shallotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.