Kintsugi Counseling Professional Limited Liability Company

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

KINTSUGI COUNSELING PROFESSIONAL LIMITED LIABILITY COMPANY

Practice address

322 Lamar Ave Ste 209
Charlotte, NC 28204-2436

Phone

(704) 644-9613

NPI assigned

Oct 7, 2019

Organization subpart

No

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

Authorized official

Name

Naomi De la Cruz SpencerNPI 1689191983

Title

Owner Therapist

Phone

(704) 644-9613

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Locations

Practitioners 1

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

• Naomi Matsui De la Cruz Spencer

  • Clinical Social Worker
  • Charlotte, NC
  • NPI 1689191983
  NPD Authorized official

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

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570406400000",
    "number": "1679114102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 EASTCREST DR APT 202",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282058277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 LAMAR AVE STE 209",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042436",
            "telephone_number": "704-644-9613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINTSUGI COUNSELING PROFESSIONAL LIMITED LIABILITY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-07",
        "last_updated": "2019-10-07",
        "status": "A",
        "authorized_official_last_name": "DE LA CRUZ SPENCER",
        "authorized_official_first_name": "NAOMI",
        "authorized_official_title_or_position": "OWNER THERAPIST",
        "authorized_official_telephone_number": "704-644-9613"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR PRIVATE INSURANCE",
            "identifier": "1689191983",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR PRIVATE INSURANCE",
            "identifier": "1962854505",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "naomi@kintsugipllc.com",
            "affiliation": "N",
            "endpointDescription": "Secure Business Email",
            "address_1": "322 LaMar Ave Ste 209",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282042436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Denise O. Kinser, LCSW
• Ellen Kinser, LCMHC
• Jennifer M. Kinser, CRNA
• Christian Kinsley
• Kinsoul Support Services LLC
• Kinvara Chiropractic & Functional Health PLLC
• Adam James Kinzel, M.D.
• Alexandria Nicole Kinzel, PA-C
• Eva Marie Kinzer, FNP
• Carmen Elizbeth Kiper, MD

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.