Karen Michelle Soutullo

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A11927 Issued in NC

Practice address

3505 Village Dr Ste 101
Fayetteville, NC 28304-4514

Phone

(615) 463-6669

NPI assigned

Oct 13, 2015

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

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

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centerstone of Tennessee, Inc.Group PAC ID 9739088113, 114 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Centerstone of Tennesse Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fayetteville, NC
  • NPI 1609482439
  Medicare reassignment Care Compare group NPD
• Centerstone of Tennessee, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Manhattan, KS
  • NPI 1023900651
  NPD

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

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1609247964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 VILLAGE DR STE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044514",
            "telephone_number": "615-463-6669",
            "fax_number": "910-221-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 VILLAGE DR STE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044514",
            "telephone_number": "615-463-6669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTULLO",
        "first_name": "KAREN",
        "middle_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-13",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A11927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Family Markets LLC (Southern Family Market)
• Southern Healthcare Network
• Southern Hospitality Home Support Care
• Southern Internal Medicine, PC
• Amy E. Southworth
• Sammy M Soza III
• Jennifer Mode Spackman, PSY.D.
• Jalen Spain
• Andrew Jeffrey Spangler
• Caroline Mainwaring Spangler

• Mental Health Counselor in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.