NPIMap

Organization Active NPI

Jade Integrative Counseling and Wellness, PLLC

  • Mental Health Counselor
  • Charlotte, NC
National Provider Identifier
1245879022
Registry record updated Dec 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
JADE INTEGRATIVE COUNSELING AND WELLNESS, PLLC
Practice address
5970 Fairview Rd Ste 420
Charlotte, NC 28210-3167
Phone
(980) 701-4192
Fax
(980) 701-4194
NPI assigned
Dec 27, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2019

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

Authorized official

Name
Mrs. Charryse A Johnson, MA, LPCNPI 1740658376
Title
Owner
Phone
(980) 701-4192

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X

Addresses

Primary practice location

5970 Fairview Rd Ste 420
Charlotte, NC 28210-3167

Mailing address

5970 Fairview Rd Ste 420
Charlotte, NC 28210-3167
Phone (980) 701-4192

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address charryse@jadeintegrativewellness.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1577404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577404800000",
    "number": "1245879022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5970 FAIRVIEW RD STE 420",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103167",
            "telephone_number": "980-701-4192",
            "fax_number": "980-701-4194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5970 FAIRVIEW RD STE 420",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103167",
            "telephone_number": "980-701-4192",
            "fax_number": "980-701-4194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JADE INTEGRATIVE COUNSELING AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-27",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CHARRYSE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "980-701-4192",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charryse@jadeintegrativewellness.com",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5970 Fairview Rd Ste 420",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282103167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.