Active NPI
Charles Douglas Prince, LPC, ALPS
- Professional Counselor
- Pedro, OH
National Provider Identifier
1821362153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2158
- Practice address
- 115 Private Road 977
Pedro, OH 45659-8608 - Phone
- (740) 534-1386
- NPI assigned
- Mar 5, 2012
- Last updated
- Mar 18, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | C.1801567 | OH | |
| Counselor | 101Y00000X | 276481 | WV | |
| Mental Health Counselor | 101YM0800X | 123 | WV | |
| Professional Counselor | 101YP2500X | 2158 | WV | Primary |
Addresses
Primary practice location
115 Private Road 977
Pedro, OH 45659-8608
Mailing address
115 Private Road 977
Pedro, OH 45659-8608
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005355002 | Medicaid | WV |
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 |
|---|---|---|---|
| C.1801567 | OH | MD | Counselor |
| 276481 | WV | MD | Counselor |
| 123 | WV | MD | Professional Counselor |
| 2158 | WV | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Necco, LLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679097600000",
"number": "1821362153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 PRIVATE ROAD 977",
"city": "PEDRO",
"state": "OH",
"postal_code": "456598608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 PRIVATE ROAD 977",
"city": "PEDRO",
"state": "OH",
"postal_code": "456598608",
"telephone_number": "740-534-1386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRINCE",
"first_name": "CHARLES",
"middle_name": "DOUGLAS",
"credential": "LPC, ALPS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-05",
"last_updated": "2023-03-18",
"certification_date": "2023-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OH",
"license": "C.1801567",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WV",
"license": "276481",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WV",
"license": "123",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WV",
"license": "2158",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005355002",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pedro, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.