Kristina Nichole Taylor Clemmons, LCMHC, LCAS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

8665 Issued in NC

Practice address

120 Coastal Horizons Dr
Shallotte, NC 28470-6094

Phone

(910) 754-4515

NPI assigned

May 2, 2011

Last updated

Jan 17, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1304294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1467743930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126431",
            "telephone_number": "910-343-0145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 COASTAL HORIZONS DR",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284706094",
            "telephone_number": "910-754-4515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 Doctors Cir Ste 1",
            "address_purpose": "LOCATION",
            "city": "Supply",
            "state": "NC",
            "postal_code": "284626358",
            "country_code": "US",
            "telephone_number": "910-754-4233",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4036 Bus 17 East Bldg 600",
            "address_purpose": "LOCATION",
            "city": "Bolivia",
            "state": "NC",
            "postal_code": "284222842",
            "country_code": "US",
            "telephone_number": "910-703-8800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAYLOR CLEMMONS",
        "first_name": "KRISTINA",
        "middle_name": "NICHOLE",
        "name_prefix": "Mrs.",
        "credential": "LCMHC, LCAS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-02",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "3394",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A8665",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "8665",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "8665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Shallotte, NC
• Providers in Shallotte, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.