A Kaleidoscope Mind PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

A KALEIDOSCOPE MIND PLLC

Practice address

144 N Cherry St Ste 4
Kernersville, NC 27284-2800

Phone

(336) 515-3630

NPI assigned

Mar 19, 2022

Last updated

Apr 20, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jody L Nash, MA, LCMHC, LCAS

Title

Owner

Phone

(336) 577-1759

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1647648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1548919418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2142 CHERRYWOOD DR",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129388",
            "telephone_number": "336-577-1759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 N CHERRY ST STE 4",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842800",
            "telephone_number": "336-515-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A KALEIDOSCOPE MIND PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-19",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "NASH",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-577-1759",
        "authorized_official_credential": "MA, LCMHC, LCAS"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Kernersville, NC
• Providers in Kernersville, 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 Apr 20, 2022; 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.