Active NPI
Jodi Shaver Callahan, LPC, LCAS
- Mental Health Counselor
- Winston Salem, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 9585
- Practice address
- 175 Kimel Park Dr Ste 100
Winston Salem, NC 27103-6951 - Phone
- (336) 718-3550
- NPI assigned
- Jan 25, 2012
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3063 | NC | |
| Professional Counselor | 101YP2500X | 9585 | NC | |
| Mental Health Counselor | 101YM0800X | 9585 | NC | Primary |
Addresses
Primary practice location
175 Kimel Park Dr Ste 100
Winston Salem, NC 27103-6951
Mailing address
PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 718-3550
Other practice location 1
284 Executive Park Drive
Suite 100
Concord, NC 28025-1894
Phone (704) 939-1100
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jcallahan293552@direct.novanthealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9585 | NC | MD | Professional Counselor |
| 3063 | NC | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forsyth Memorial Hospital, Inc. | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Current | Accepting new patients |
Locations
200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424
175 Kimel Park Dr
Ste 100
Winston Salem, NC 27103
Phone (336) 277-1811
Interoperability endpoints
- jcallahan293552@direct.novanthealth.org
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba NH Forsyth Primary Care Clinics
- Family Medicine Physician
- Winston Salem, NC
- NPI 1104548874
-
dba Novant Health Pediatric Neurology & Sleep
- Neurology with Special Qualifications in Child Neurology Physician
- Charlotte, NC
- NPI 1366409492
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726790400000",
"number": "1386915148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751803",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751803",
"telephone_number": "336-718-3550",
"fax_number": "336-277-6981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 KIMEL PARK DR STE 100",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271036951",
"telephone_number": "336-718-3550"
}
],
"practiceLocations": [
{
"address_1": "284 EXECUTIVE PARK DRIVE",
"address_2": "SUITE 100",
"address_purpose": "LOCATION",
"city": "CONCORD",
"state": "NC",
"postal_code": "280251894",
"country_code": "US",
"telephone_number": "704-939-1100",
"fax_number": "704-939-1173",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CALLAHAN",
"first_name": "JODI",
"middle_name": "SHAVER",
"credential": "LPC, LCAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-25",
"last_updated": "2024-09-20",
"certification_date": "2024-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "3063",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "9585",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "9585",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jcallahan293552@direct.novanthealth.org",
"affiliation": "N",
"address_1": "284 EXECUTIVE PARK DRIVE",
"address_2": "SUITE 100",
"city": "CONCORD",
"state": "NC",
"country_code": "US",
"postal_code": "280251894",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.