Active NPI
Casaundria Penn
- Counselor
- Gastonia, NC
National Provider Identifier
1669597225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 6523
- Practice address
- 436 E Long Ave
Gastonia, NC 28054-2516 - Phone
- (704) 853-8227
- NPI assigned
- Mar 20, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 6523 | NC | Primary |
| Mental Health Counselor | 101YM0800X | 6523 | NC | |
| Professional Counselor | 101YP2500X | 6523 | NC |
Addresses
Primary practice location
436 E Long Ave
Gastonia, NC 28054-2516
Mailing address
PO Box 215
Gastonia, NC 28053-0215
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6523 | NC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brightside Medical of New Jersey, P.C. | Current | Accepting new patients | |
| Vitae Health Medical North Carolina, PLLC | Current | Accepting new patients | |
| Familiy Works Inc. | Mental Health | Past | Accepting new patients |
Locations
2261 Market St
San Francisco, CA 94114
Phone (213) 337-4615
550 Glenwood Dr
Mooresville, NC 28115
Phone (704) 644-4797
3064 Wake Forest Rd
Raleigh, NC 27609
Phone (415) 360-3349
Organizations & group practices 3
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.
-
- Internal Medicine Physician
- Mooresville, NC
- NPI 1265064414
-
- Mental Health Counselor
- Gastonia, NC
- NPI 1811006778
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252368000000",
"number": "1669597225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 215",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280530215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "436 E LONG AVE",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280542516",
"telephone_number": "704-853-8227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "CASAUNDRIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2009-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "6523",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "6523",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "6523",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gastonia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2009; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.