Active NPI
Provisions Counseling Services
- Counselor
- Charlotte, NC
National Provider Identifier
1457861072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 1484
- Legal business name
- PROVISIONS COUNSELING SERVICES
- Practice address
- 1000 Baxter St
Charlotte, NC 28204-2859 - Phone
- (704) 750-0655
- NPI assigned
- Oct 10, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Shiricka Lashaye Fair, PHD, LMFT
- Title
- Executive Director
- Phone
- (704) 750-0655
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 1484 | NC | Primary |
| Marriage & Family Therapist | 106H00000X | 1484 | NC |
Addresses
Primary practice location
1000 Baxter St
Charlotte, NC 28204-2859
Mailing address
5115 Mintvale Dr
Charlotte, NC 28269-1689
Phone (704) 750-0655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326339185 | Medicaid | NC |
National Provider Directory
National Provider DirectoryPractitioners & 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": "1507593600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1512518400000",
"number": "1457861072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5115 MINTVALE DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282691689",
"telephone_number": "704-750-0655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 BAXTER ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282042859",
"telephone_number": "704-750-0655"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROVISIONS COUNSELING SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2017-10-10",
"last_updated": "2017-12-06",
"status": "A",
"authorized_official_last_name": "FAIR",
"authorized_official_first_name": "SHIRICKA",
"authorized_official_middle_name": "LASHAYE",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "704-750-0655",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHD, LMFT"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Counselor",
"state": "NC",
"license": "1484",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "NC",
"license": "1484",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1326339185",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
- Providence Physical Medicine PC
- Providence Psychiatric & Behavioral Health Services, Inc
- Providence Transportation Solutions, LLC
- Providence View Counseling & Play Therapy, PLLC
- Providential Care Services LLC
- Provital Transit, LLC
- Provizions Care LLC
- Benjamin Thomas Pruden, M.D.
- Lindsay McCarthy Pruden, PA
- James William Pruett, PH.D; D.MIN.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.