Southport Counseling Services, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SOUTHPORT COUNSELING SERVICES, PLLC

Practice address

3960 Executive Park Blvd Ste 3
Southport, NC 28461-8184

Phone

(910) 854-0371

Fax

(910) 854-0371

NPI assigned

Oct 17, 2018

Organization subpart

No

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

Authorized official

Name

Kymra F Stewart, LCSWNPI 1053348177

Title

Provider/Owner

Phone

(828) 385-1889

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 2

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

• Kymra Fowler Stewart, LCSW

  • Clinical Social Worker
  • Southport, NC
  • NPI 1053348177
  Medicare reassignment NPD Authorized official
• Ronald Field, PH.D.

  • Clinical Psychologist
  • Wappingers Falls, NY
  • NPI 1952416083
  NPD (past)

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

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539734400000",
    "number": "1942776943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3960 EXECUTIVE PARK BLVD STE 3",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284618184",
            "telephone_number": "910-854-0371",
            "fax_number": "910-854-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3960 EXECUTIVE PARK BLVD STE 3",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284618184",
            "telephone_number": "910-854-0371",
            "fax_number": "910-854-0371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPORT COUNSELING SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-17",
        "last_updated": "2018-10-17",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "KYMRA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "828-385-1889",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "79895",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Ann Smith, OD
• Smithville Cardiology, PA
• Molly Ann Smyser, D.C.
• South East Access Inc
• Southern Cross
• Southport Eye Care OD PLLC
• Southport Internal Medicine PA
• Southport Pulmonary Medicine, PLLC
• Southport Surgical Associates, P.a.
• Southport Urgent Care

• Clinical Social Worker in Southport, NC
• Providers in Southport, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; 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.