NPIMap

Organization Active NPI

Kickstarting Inspiration & Nourishing Gentle Souls LLC

  • Clinical Social Worker
  • Mint Hill, NC
National Provider Identifier
1326775883
Registry record updated Aug 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
KICKSTARTING INSPIRATION & NOURISHING GENTLE SOULS LLC
Practice address
7319 Matthews Mint Hill Rd Ste I
Mint Hill, NC 28227-7866
Phone
(336) 908-9595
NPI assigned
Aug 4, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2022

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

Authorized official

Name
Mr. Zaques Jamonez McCullough, LCSW-ANPI 1861165094
Title
Owner
Phone
(252) 375-0694

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

7319 Matthews Mint Hill Rd Ste I
Mint Hill, NC 28227-7866

Mailing address

7319 Matthews Mint Hill Rd Ste I
Mint Hill, NC 28227-7866
Phone (336) 908-9595

National Provider Directory

National Provider Directory

Locations

7319 Matthews Mint Hill Rd
Ste I
Mint Hill, NC 28227
Phone (336) 908-9595

Practitioners & affiliated clinicians

Practitioners 1

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": "1659571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659571200000",
    "number": "1326775883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7319 MATTHEWS MINT HILL RD STE I",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282277866",
            "telephone_number": "336-908-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7319 MATTHEWS MINT HILL RD STE I",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282277866",
            "telephone_number": "336-908-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICKSTARTING INSPIRATION & NOURISHING GENTLE SOULS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-04",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "ZAQUES",
        "authorized_official_middle_name": "JAMONEZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-375-0694",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW-A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mint Hill, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; 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.