Active NPI
Theresa Maria Yandoli-Lee
- Mental Health Counselor
- Charlotte, NC
National Provider Identifier
1619745304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A19479
- Practice address
- 5601 Executive Center Dr
Charlotte, NC 28212-8863 - Phone
- (704) 537-1022
- NPI assigned
- Dec 13, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | A19479 | NC | Primary |
Addresses
Primary practice location
5601 Executive Center Dr
Charlotte, NC 28212-8863
Mailing address
555 Old Prison Camp Rd
Polkton, NC 28135-7149
Phone (704) 690-1808
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 |
|---|---|---|---|
| A19479 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702425600000",
"number": "1619745304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 OLD PRISON CAMP RD",
"city": "POLKTON",
"state": "NC",
"postal_code": "281357149",
"telephone_number": "704-690-1808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5601 EXECUTIVE CENTER DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282128863",
"telephone_number": "704-537-1022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YANDOLI-LEE",
"first_name": "THERESA",
"middle_name": "MARIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-12-13",
"last_updated": "2023-12-13",
"certification_date": "2023-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "A19479",
"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 Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.