Carrie Konieczki, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

178.015162 Issued in IL

Practice address

1101 E Winter Ave
Danville, IL 61832-2295

Phone

(217) 651-6801

Fax

(217) 651-6802

NPI assigned

Sep 10, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Two Roads Wellness Clinic, LLC

  • Primary Care Nurse Practitioner
  • Danville, IL
  • NPI 1417329426

  Counselor

  NPD

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1508415696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 OAK ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618321715",
            "telephone_number": "217-799-9161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 E WINTER AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618322295",
            "telephone_number": "217-651-6801",
            "fax_number": "217-651-6802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONIECZKI",
        "first_name": "CARRIE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-10",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "178.015162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "contact@tworoadswellnessclinic.com",
            "affiliation": "N",
            "address_1": "1101 E Winter Ave",
            "city": "Danville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "618322295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lukas Knight
• Kort Roderick Knous, MD
• Thomas C Koehler, M.D.
• Paula Koelbl
• Timothy Alan Kohlbecker, MSW
• Dong Koo, MD
• Yeonsuk Choi Koo, M.D.
• Timothy Franklin Koons, LCSW
• Brian Francis Korus, PHAMRD
• Jennifer Koser, NP

• All providers in Danville, IL
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.