Individual provider Active NPI

Nicole Marie Simon

  • Mental Health Counselor
  • Raeford, NC
National Provider Identifier
1235751108
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
402 Harris Ave
Raeford, NC 28376-3112
Phone
(910) 875-5590
NPI assigned
May 13, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

402 Harris Ave
Raeford, NC 28376-3112

Mailing address

402 Harris Ave
Raeford, NC 28376-3112
Phone (910) 875-5590

Other practice location 1

159 Barkley Ct
Raeford, NC 28376-9220
Phone (618) 550-9362

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
I20240415002055 NC Practitioner - Mental Health Counselor 7012356744 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greater Vision Counseling and Consulting Agency PLLCGroup PAC ID 5698049476, 6 clinicians

Practice addresses (Care Compare)

402 Harris Ave
Raeford, NC 28376-3112
Phone (910) 875-5590

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16319NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Vision Counseling & Consulting Agency PLLC CurrentSince Feb 16, 2024 Accepting new patients

Locations

402 Harris Ave
Raeford, NC 28376
Phone (910) 848-1638

632 W Prospect Ave
Raeford, NC 28376
Phone (910) 390-0107

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1235751108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 HARRIS AVE",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283763112",
            "telephone_number": "910-875-5590",
            "fax_number": "910-875-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 HARRIS AVE",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283763112",
            "telephone_number": "910-875-5590"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "159 Barkley Ct",
            "address_purpose": "LOCATION",
            "city": "Raeford",
            "state": "NC",
            "postal_code": "283769220",
            "country_code": "US",
            "telephone_number": "618-550-9362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMON",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-13",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raeford, NC

Sources for this page

Verify at the official NPI Registry.