Southpark Psychotherapy PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SOUTHPARK PSYCHOTHERAPY PLLC

Doing business as

SouthPark Psychotherapy

Practice address

5950 Fairview Rd Ste 770
Charlotte, NC 28210-3142

Phone

(980) 999-0501

Fax

(980) 980-5841

NPI assigned

Dec 19, 2022

Last updated

Jul 15, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sara Elizabeth Wilkerson, LCMHCNPI 1528677226

Title

Counselor and Owner

Phone

(980) 999-0501

Specialties & licenses 1

Addresses

Other names 1

• SouthPark Psychotherapy Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sara Wilkerson, LCMHC

  • Mental Health Counselor
  • Charlotte, NC
  • NPI 1528677226
  Medicare reassignment Care Compare group NPD Authorized official
• Katherine Maynor, MSW, LCSW

  • Clinical Social Worker
  • Charlotte, NC
  • NPI 1790346872
  Medicare reassignment Care Compare group NPD
• Tara Cantrell, LPCA

  • Professional Counselor
  • Horse Shoe, NC
  • NPI 1194179291

  Mental Health

  NPD (past)
• Lex Guo

  • Mental Health Counselor
  • Charlotte, NC
  • NPI 1386356046
  NPD (past)
• Corrin Miller, LCMHCA

  • Mental Health Counselor
  • Charlotte, NC
  • NPI 1033788054
  NPD (past)

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784073600000",
    "number": "1679285043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5950 FAIRVIEW RD STE 770",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103142",
            "telephone_number": "980-999-0501",
            "fax_number": "980-980-5841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5950 FAIRVIEW RD STE 770",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103142",
            "telephone_number": "980-999-0501",
            "fax_number": "980-980-5841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPARK PSYCHOTHERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-19",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A",
        "authorized_official_last_name": "WILKERSON",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "COUNSELOR AND OWNER",
        "authorized_official_telephone_number": "980-999-0501",
        "authorized_official_credential": "LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SouthPark Psychotherapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southpark Behavioral Medicine Specialists, P.a.
• Southpark Chiropractic Center Inc
• Southpark Counseling PLLC
• Southpark Functional Medicine PLLC
• Southpark Pediatrics, P.a.
• Southpark Senior Living LLC (Place at Southpark Assisted Living and Memory Care)
• Southpark Surgery Center LLC (SouthPark Surgery Center)
• Southside Counseling Center, LLC
• Southview Dentistry
• Anna Southwick, LCMHCS

• Mental Health Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2026; 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.