Active NPI
Jody Ann Thibault, CSAC
- Addiction (Substance Use Disorder) Counselor
- Charlotte, NC
National Provider Identifier
1356671085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 2617
- Practice address
- 100 Billingsley Rd
Charlotte, NC 28211-1002 - Phone
- (704) 376-7447
- Fax
- (704) 376-3384
- NPI assigned
- Dec 31, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 2617 | NC | Primary |
Addresses
Primary practice location
100 Billingsley Rd
Charlotte, NC 28211-1002
Mailing address
429 Billingsley Rd
Charlotte, NC 28211-1007
Phone (704) 445-6900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2617 | Other | NC | CSAC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2617 | NC | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471392000000",
"number": "1356671085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "429 BILLINGSLEY RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282111007",
"telephone_number": "704-445-6900",
"fax_number": "980-406-3608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BILLINGSLEY RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282111002",
"telephone_number": "704-376-7447",
"fax_number": "704-376-3384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIBAULT",
"first_name": "JODY",
"middle_name": "ANN",
"credential": "CSAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-31",
"last_updated": "2016-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "2617",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSAC",
"identifier": "2617",
"state": "NC"
}
],
"endpoints": [],
"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 Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.