Kingsberry Counseling Services, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

9455 Issued in NC

Legal business name

KINGSBERRY COUNSELING SERVICES, PLLC

Practice address

421 Paigebrook Dr
Winston Salem, NC 27106-8744

Phone

(336) 575-5948

NPI assigned

Jan 14, 2017

Organization subpart

No

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

Authorized official

Name

Mr. John Travis Thacker, LPC, LCAS

Title

Owner

Phone

(336) 575-5948

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1484352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484352000000",
    "number": "1255877296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30312",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271300312",
            "telephone_number": "336-575-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 PAIGEBROOK DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271068744",
            "telephone_number": "336-575-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSBERRY COUNSELING SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-14",
        "last_updated": "2017-01-14",
        "status": "A",
        "authorized_official_last_name": "THACKER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "TRAVIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-575-5948",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC, LCAS"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "20293",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "9455",
            "primary": true
        },
        {
            "code": "225C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Rehabilitation Counselor",
            "state": "NC",
            "license": "00115237",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mitchel J. King, MS, LMCHA, NCC
• Ruby King
• Tramaine King
• Gilson John Kingman, MD
• Morgan J Kingrey, PA
• Carlene Wendy Kingston, MD
• Lindsay Kinkade
• Stanley Gordon Kinkaid, MD
• Kern Elise Kinley-Howard, DMD
• Linda Faye Kinley, LCSW

• Mental Health Counselor in Winston Salem, NC
• Providers in Winston Salem, 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 Jan 14, 2017; 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.