Active NPI
Kendra Woody-Simmons, LPC, CAC, SAP, NCC
- Professional Counselor
- North Charleston, SC
National Provider Identifier
1588968713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5234
- Practice address
- 6650 Rivers Ave
Suite 124
North Charleston, SC 29406-4809 - Phone
- (843) 475-9096
- Fax
- (866) 496-9934
- NPI assigned
- Jan 3, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 09052613 | SC | |
| Professional Counselor | 101YP2500X | 5234 | SC | Primary |
Addresses
Primary practice location
6650 Rivers Ave
Suite 124
North Charleston, SC 29406-4809
Mailing address
1233 Creek Stone Way
Hanahan, SC 29410-4739
Phone (843) 437-6859
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 255933 | Other | SC | NATIONAL CERTIFIED COUNSELOR |
| 5234 | Other | SC | LICENSED PROFESSIONAL COUNSELOR |
| 13334 | Other | SC | SUBSTANCE ABUSE PROFESSIONAL |
| 09052613 | Other | SC | CERTIFIED ADDICTION COUNSELOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09052613 | SC | MD | Addiction (Substance Use Disorder) Counselor |
| 5234 | SC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294012800000",
"number": "1588968713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1233 CREEK STONE WAY",
"city": "HANAHAN",
"state": "SC",
"postal_code": "294104739",
"telephone_number": "843-437-6859",
"fax_number": "866-496-9934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6650 RIVERS AVE",
"address_2": "SUITE 124",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294064809",
"telephone_number": "843-475-9096",
"fax_number": "866-496-9934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODY-SIMMONS",
"first_name": "KENDRA",
"credential": "LPC, CAC, SAP, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-03",
"last_updated": "2011-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "SC",
"license": "09052613",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "SC",
"license": "5234",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL CERTIFIED COUNSELOR",
"identifier": "255933",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED PROFESSIONAL COUNSELOR",
"identifier": "5234",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUBSTANCE ABUSE PROFESSIONAL",
"identifier": "13334",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFIED ADDICTION COUNSELOR",
"identifier": "09052613",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.