Active NPI
Kathleen Marie Connolly, PH.D.
- Professional Counselor
- Charlotte, NC
National Provider Identifier
1578899209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3919
- Practice address
- 218 E Tremont Ave
B
Charlotte, NC 28203-5059 - Phone
- (704) 331-0160
- Fax
- (704) 331-0161
- NPI assigned
- Oct 31, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3919 | NC | Primary |
Addresses
Primary practice location
218 E Tremont Ave
B
Charlotte, NC 28203-5059
Mailing address
218 E Tremont Ave
B
Charlotte, NC 28203-5059
Phone (704) 331-0160
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 13, 2024 through Sep 13, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3919 | NC | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256947200000",
"number": "1578899209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "218 E TREMONT AVE",
"address_2": "B",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282035059",
"telephone_number": "704-331-0160",
"fax_number": "704-331-0161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "218 E TREMONT AVE",
"address_2": "B",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282035059",
"telephone_number": "704-331-0160",
"fax_number": "704-331-0161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "KATHLEEN",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-31",
"last_updated": "2009-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "3919",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.