Kelly Colleen Johnson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C012146 Issued in NC

Practice address

2530 Meridian Parkway
Suite 300, PBN: 3071
Durham, NC 27713-2771

Phone

(919) 437-6627

Fax

(919) 258-2490

NPI assigned

Aug 11, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 12, 2024 through Nov 12, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kelly C. Johnson LCSW, P.L.L.C.

  dba A New Chapter Counseling Services

  • Adolescent and Children Mental Health Clinic/Center
  • Durham, NC
  • NPI 1205482460
  NPD (past) Authorized official

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

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1427573476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 RELICT DR",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275276710",
            "telephone_number": "815-878-8541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 MERIDIAN PARKWAY",
            "address_2": "SUITE 300, PBN: 3071",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277132771",
            "telephone_number": "919-437-6627",
            "fax_number": "919-258-2490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "COLLEEN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-11",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.019599",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C012146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "C012146",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE I",
            "identifier": "1427573476",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "149019599",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelly.johnson@anewchaptercs.com",
            "affiliation": "N",
            "address_1": "2530 Meridian Parkway",
            "address_2": "Suite 300, PBN: 3071",
            "city": "Durham",
            "state": "NC",
            "country_code": "US",
            "postal_code": "277132771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Karen T Johnson, OT
• Karon Falaq Johnson, LCSW
• Katherine J Johnson, L.C.S.W
• Kathryn Mary Cervino Johnson, AGACNP-BC
• Kellie Berne Johnson, LCSW
• Kendra Johnson
• Kiesha Charis Johnson
• Kim A. Johnson, R.D., L.D.N.
• Kim Graham Johnson, M.D.
• Kimberly Johnson, M.D.

• Clinical Social Worker in Durham, NC
• Providers in Durham, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.