Kingdom Creative Counseling PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C007049 Issued in NC

Legal business name

KINGDOM CREATIVE COUNSELING PLLC

Practice address

1050 Revolution Mill Dr Ste 2
Greensboro, NC 27405-5053

Phone

(336) 543-0159

Fax

(336) 663-2906

NPI assigned

May 22, 2017

Organization subpart

No

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

Authorized official

Name

Samaria M Colbert, LCSWNPI 1699077396

Title

Owner

Phone

(336) 543-0159

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Samaria M Colbert Former legal business name

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

Locations

Practitioners 1

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

• Samaria Maria Colbert, LCSW

  • Clinical Social Worker
  • Greensboro, NC
  • NPI 1699077396
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1700313780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14222",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274154222",
            "telephone_number": "336-543-0159",
            "fax_number": "336-663-2906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 REVOLUTION MILL DR STE 2",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274055053",
            "telephone_number": "336-543-0159",
            "fax_number": "336-663-2906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGDOM CREATIVE COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-22",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SAMARIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-543-0159",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "C007049",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "C007049",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699077396",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaria M Colbert",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Nikia King
• Olivia Grace King, DO
• Ricky L King II, LCSWA
• Sephara King
• Shakyra Ambreial King
• Lorraine Kingham, PT, MTC, MHSC
• Thomas Kingsley, MD
• Victoria Kirsten Kingsley, DO
• Kelly Marie Kinnear
• Carol Ann Kinneman, PT

• Mental Health Counselor in Greensboro, NC
• Providers in Greensboro, 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 Dec 18, 2024; 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.