NPIMap

Organization Active NPI

Phoenix Counseling Center

  • Addiction (Substance Use Disorder) Counselor
  • Shelby, NC
National Provider Identifier
1831377563
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
PHOENIX COUNSELING CENTER
Practice address
804 N Lafayette St Ste 2
Shelby, NC 28150-3898
Phone
(704) 476-4106
NPI assigned
Feb 5, 2008
Organization subpart
Yes
Parent organization
PHOENIX COUNSELING CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Kevin Paul Oliver, MA, MPA
Title
Executive Director
Phone
(704) 921-3070

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X NC Primary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X NC
Case Management Agency 251B00000X NC
Community/Behavioral Health Agency 251S00000X NC

Addresses

Primary practice location

804 N Lafayette St Ste 2
Shelby, NC 28150-3898

Mailing address

839 Majestic CT Ste 1
Gastonia, NC 28054-5152
Phone (704) 396-6747

Other practice location 1

917 1st St
Shelby, NC 28150-3958
Phone (704) 476-4106

Other practice location 2

631 Brawley School Rd Ste 200B
Mooresville, NC 28117-6209
Phone (704) 491-0829

Other identifiers 2

IdentifierTypeStateIssuer
1831377563OtherNCNPI
1831377563MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120823000785 NC Part B Supplier - Clinic/Group Practice 8426205584 Receives reassigned benefits from 2 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gastonia, NC; Lincolnton, NC; Shelby, NC

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Counseling Center9 organizations share this tax ID, including this one
Part of
Phoenix Counseling Center

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

839 Majestic Ct
Ste 1
Gastonia, NC 28054
Phone (704) 867-6188

200 S Post Rd
Ste 2
Shelby, NC 28152
Phone (704) 476-4106

Practitioners & affiliated clinicians

Practitioners 8

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": "1202169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1831377563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "839 MAJESTIC CT STE 1",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280545152",
            "telephone_number": "704-396-6747",
            "fax_number": "704-854-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 N LAFAYETTE ST STE 2",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503898",
            "telephone_number": "704-476-4106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "917 1st St",
            "address_purpose": "LOCATION",
            "city": "Shelby",
            "state": "NC",
            "postal_code": "281503958",
            "country_code": "US",
            "telephone_number": "704-476-4106",
            "fax_number": "704-476-4021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "631 Brawley School Rd Ste 200B",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281176209",
            "country_code": "US",
            "telephone_number": "704-491-0829",
            "fax_number": "704-921-3066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHOENIX COUNSELING CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX COUNSELING CENTER",
        "enumeration_date": "2008-02-05",
        "last_updated": "2022-07-21",
        "certification_date": "2021-07-06",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-921-3070",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, MPA"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1831377563",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831377563",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.