NPIMap

Organization Active NPI

Kernersville Counseling Center PLLC

  • Community/Behavioral Health Agency
  • Kernersville, NC
National Provider Identifier
1669836136
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
10258 Issued in NC
Legal business name
KERNERSVILLE COUNSELING CENTER PLLC
Practice address
210 N Main St Ste 210
Kernersville, NC 27284-4003
Phone
(336) 283-3830
Fax
(336) 283-3827
NPI assigned
Apr 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Brotherton, LCMHCSNPI 1467893958
Title
Owner
Phone
(336) 283-3830

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 10258 NC Primary

Addresses

Primary practice location

210 N Main St Ste 210
Kernersville, NC 27284-4003

Mailing address

210 N Main St Ste 210
Kernersville, NC 27284-4003
Phone (336) 283-3830

Other practice location 1

125 Allen St
Kernersville, NC 27284-2940
Phone (336) 283-3830

Other practice location 2

1180 N Main St
Kernersville, NC 27284-9856
Phone (336) 283-3830

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251215003926 NC Part B Supplier - Clinic/Group Practice 9537653639 Receives reassigned benefits from 7 practitioners
Practice locations: Kernersville, NC

National Provider Directory

National Provider Directory

Locations

210 N Main St
Ste 210
Kernersville, NC 27284
Phone (336) 238-3830

1180 N Main St
Kernersville, NC 27284
Phone (336) 283-3820

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1669836136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N MAIN ST STE 210",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272844003",
            "telephone_number": "336-283-3830",
            "fax_number": "336-283-3827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N MAIN ST STE 210",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272844003",
            "telephone_number": "336-283-3830",
            "fax_number": "336-283-3827"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Allen St",
            "address_purpose": "LOCATION",
            "city": "Kernersville",
            "state": "NC",
            "postal_code": "272842940",
            "country_code": "US",
            "telephone_number": "336-283-3830",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1180 N Main St",
            "address_purpose": "LOCATION",
            "city": "Kernersville",
            "state": "NC",
            "postal_code": "272849856",
            "country_code": "US",
            "telephone_number": "336-283-3830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KERNERSVILLE COUNSELING CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-11",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A",
        "authorized_official_last_name": "BROTHERTON",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-283-3830",
        "authorized_official_credential": "LCMHCS"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "10258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.