NPIMap

Organization Active NPI

Southeast Child & Family Guidance, PLLC

  • Mental Health Counselor
  • Waxhaw, NC
National Provider Identifier
1356629273
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SOUTHEAST CHILD & FAMILY GUIDANCE, PLLC
Practice address
105 Waxhaw Professional Park Dr Ste H
Waxhaw, NC 28173-5018
Phone
(704) 770-8049
Fax
(704) 256-9968
NPI assigned
Jul 26, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Authorized official

Name
Kathleen Bready, LCMHC
Title
Owner/Manager
Phone
(704) 770-8049

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

105 Waxhaw Professional Park Dr Ste H
Waxhaw, NC 28173-5018

Mailing address

105 Waxhaw Professional Park Dr Ste H
Waxhaw, NC 28173-5018
Phone (704) 770-8049

National Provider Directory

National Provider Directory

Locations

400 N Broome St
Ste 301
Waxhaw, NC 28173
Phone (704) 256-0305

105 Waxhaw Professional Park Dr
Ste H
Waxhaw, NC 28173
Phone (704) 256-0305

Practitioners & affiliated clinicians

Practitioners 11

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": "1311638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1356629273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 WAXHAW PROFESSIONAL PARK DR STE H",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281735018",
            "telephone_number": "704-770-8049",
            "fax_number": "704-256-9968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WAXHAW PROFESSIONAL PARK DR STE H",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281735018",
            "telephone_number": "704-770-8049",
            "fax_number": "704-256-9968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST CHILD & FAMILY GUIDANCE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-26",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "BREADY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "704-770-8049",
        "authorized_official_credential": "LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waxhaw, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; 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.