NPIMap

Organization Active NPI

Banner Consulting and Counseling of North Carolina, PLLC

  • Clinical Social Worker
  • Fayetteville, NC
National Provider Identifier
1710508205
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
BANNER CONSULTING AND COUNSELING OF NORTH CAROLINA, PLLC
Practice address
2525 Raeford Rd Ste B
Fayetteville, NC 28305-5092
Phone
(910) 491-8901
Fax
(910) 891-8902
NPI assigned
May 6, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2020

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

Authorized official

Name
Carol Michelle Duke, LCSWNPI 1194192237
Title
Owner
Phone
(912) 335-9490

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

2525 Raeford Rd Ste B
Fayetteville, NC 28305-5092

Mailing address

2525 Raeford Rd Ste B
Fayetteville, NC 28305-5092
Phone (910) 491-8901

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220323000149 NC Part B Supplier - Clinic/Group Practice 4981099215 Receives reassigned benefits from 7 practitioners
Practice locations: Fayetteville, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1588723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588723200000",
    "number": "1710508205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 RAEFORD RD STE B",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055092",
            "telephone_number": "910-491-8901",
            "fax_number": "910-891-8902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 RAEFORD RD STE B",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055092",
            "telephone_number": "910-491-8901",
            "fax_number": "910-891-8902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER CONSULTING AND COUNSELING OF NORTH CAROLINA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-06",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A",
        "authorized_official_last_name": "DUKE",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-335-9490",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; 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.