Active NPI
Carlson Andrews Theodore, LCMHC
- Mental Health Counselor
- Rougemont, NC
National Provider Identifier
1699097063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 7744
- Practice address
- 96 Elderberry LN
Rougemont, NC 27572-9275 - Phone
- (919) 240-9192
- NPI assigned
- Feb 25, 2010
- Last updated
- May 22, 2023
- Sex
- Male
- 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 | 7744 | NC | Primary |
Addresses
Primary practice location
96 Elderberry LN
Rougemont, NC 27572-9275
Mailing address
96 Elderberry LN
Rougemont, NC 27572-9275
Phone (919) 240-9192
Other practice location 1
100 Loop St
Clinton, NC 28328-4062
Phone (910) 596-2221
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7744 | Other | NC | NORTH CAROLINA BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231129003223 | NC | Practitioner - Mental Health Counselor | 2567810617 | Practice locations: Rougemont, NC |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684713600000",
"number": "1699097063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "96 ELDERBERRY LN",
"city": "ROUGEMONT",
"state": "NC",
"postal_code": "275729275",
"telephone_number": "919-240-9192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "96 ELDERBERRY LN",
"city": "ROUGEMONT",
"state": "NC",
"postal_code": "275729275",
"telephone_number": "919-240-9192"
}
],
"practiceLocations": [
{
"address_1": "100 Loop St",
"address_purpose": "LOCATION",
"city": "Clinton",
"state": "NC",
"postal_code": "283284062",
"country_code": "US",
"telephone_number": "910-596-2221",
"fax_number": "910-596-2229",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THEODORE",
"first_name": "CARLSON",
"middle_name": "ANDREWS",
"name_prefix": "Mr.",
"credential": "LCMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-02-25",
"last_updated": "2023-05-22",
"certification_date": "2023-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "7744",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORTH CAROLINA BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS",
"identifier": "7744",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rougemont, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.