Charlene A Smith

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

15897 Issued in FL

Practice address

358 Stiles Ave
Orange Park, FL 32073-4012

Phone

(904) 264-8311

Fax

(904) 264-8377

NPI assigned

Jun 13, 2018

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Telehealth

Offers telehealth services

Group practices

Acknowledge U Counseling and Consulting ServicesGroup PAC ID 9335682152, 2 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.

• Acknowledge U Counseling & Consulting Services

  • Mental Health Counselor
  • Jacksonville, FL
  • NPI 1063158061
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1528848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1609369743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "358 STILES AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734012",
            "telephone_number": "904-264-8311",
            "fax_number": "904-264-8377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 STILES AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734012",
            "telephone_number": "904-264-8311",
            "fax_number": "904-264-8377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CHARLENE",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-13",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "15897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "csmith@psoj.net",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "358 Stiles Ave",
            "city": "Orange Park",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320734012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Small Talk Inc
• Smart Moves Physiotherapy, LLC
• Smith Endodontics
• Atiya Smith-Wilson, PMHNP
• Amy Smith
• Delois Hunter Smith, LPC, NCC
• Dillon Smith, DO
• Jason Smith, MD
• Jessica Leigh Gleaton Smith, A.P., D.O.M.
• Kaitlyn L Smith, DPT

• Mental Health Counselor in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; 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.