Active NPI
Jessica Squires Carlyle, LCMHCA
- Mental Health Counselor
- Greenville, NC
National Provider Identifier
1801636618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A20041
- Practice address
- 313 Clifton St
Greenville, NC 27858-5008 - Phone
- (252) 353-0100
- NPI assigned
- May 29, 2024
- Sex
- Female
- Sole proprietor
- No
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 | A20041 | NC | Primary |
Addresses
Primary practice location
313 Clifton St
Greenville, NC 27858-5008
Mailing address
2206 Kathleen Dr
Greenville, NC 27858-9578
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A20041 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719360000000",
"number": "1801636618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2206 KATHLEEN DR",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278589578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "313 CLIFTON ST",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278585008",
"telephone_number": "252-353-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLYLE",
"first_name": "JESSICA",
"middle_name": "SQUIRES",
"credential": "LCMHCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-29",
"last_updated": "2024-06-26",
"certification_date": "2024-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "A20041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.