Individual provider Active NPI

Jacqueline C Thompson, LCMHC

  • Mental Health Counselor
  • Greensboro, NC
National Provider Identifier
1508491457
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
14086 Issued in NC
Practice address
301 E Wendover Ave Ste 400
Greensboro, NC 27401-1207
Phone
(336) 832-3150
Fax
(336) 832-3151
NPI assigned
Mar 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 14086 NC Primary

Addresses

Primary practice location

301 E Wendover Ave Ste 400
Greensboro, NC 27401-1207

Mailing address

PO Box 745040
Atlanta, GA 30374-5040

Other names 1

  • Jacqueline C Culler Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jculler637310@direct.conehealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240520003258 NC Practitioner - Mental Health Counselor 3678915808 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14086NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Moses Cone Physician Services, Inc. CurrentSince Mar 30, 2024 Accepting new patients
Moses Cone Physician Services, Inc. Current Accepting new patients
Moses Cone Physician Services Inc CurrentSince Mar 30, 2024 Accepting new patients

Locations

301 E Wendover Ave
Ste 400
Greensboro, NC 27401
Phone (336) 832-3150

1103 N Elm St
Ste 300
Greensboro, NC 27401
Phone (336) 271-3331

301 E Wendover Ave
Ste 311
Greensboro, NC 27401
Phone (336) 272-6161

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1508491457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 745040",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303745040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E WENDOVER AVE STE 400",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011207",
            "telephone_number": "336-832-3150",
            "fax_number": "336-832-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "JACQUELINE",
        "middle_name": "C",
        "credential": "LCMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-10",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "14086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jculler637310@direct.conehealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "301 E Wendover Ave Ste 400",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274011207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "CULLER",
            "middle_name": "C",
            "credential": "LPC-A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.