Individual provider Active NPI

Marquita Shana Hill, LCMHCA

  • Mental Health Counselor
  • Mount Holly, NC
National Provider Identifier
1962904102
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
A16221 Issued in NC
Practice address
124 S Hawthorne St
Mt Holly, NC 28120-1663
Phone
(704) 874-9005
NPI assigned
Mar 4, 2018
Last updated
Jun 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 21615 NC
Mental Health Counselor 101YM0800X A16221 NC Primary

Addresses

Primary practice location

124 S Hawthorne St
Mt Holly, NC 28120-1663

Mailing address

200 E 2ND Ave
Gastonia, NC 28052-4358
Phone (704) 874-1900

Other practice location 1

5970 Fairview Rd Ste 126
Charlotte, NC 28210-2100
Phone (704) 762-1361

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

LicenseStateTypeSpecialty
21615NCMDAddiction (Substance Use Disorder) Counselor
A16221NCMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Gaston Family Health Services, Inc. CurrentSince Jun 30, 2024 Accepting new patients
Bridges Therapeutic Services PLLC Mental Health PastSince Jan 1, 2021 Accepting new patients

Locations

200 E 2nd Ave
Gastonia, NC 28052
Phone (704) 874-1904

124 S Hawthorne St
Mt Holly, NC 28120

Interoperability endpoints

  • Direct secure messaging: mhill722475@direct.ochin.org

Organizations & group practices 2

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": "1520121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1962904102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 2ND AVE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524358",
            "telephone_number": "704-874-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 S HAWTHORNE ST",
            "city": "MT HOLLY",
            "state": "NC",
            "postal_code": "281201663",
            "telephone_number": "704-874-9005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5970 Fairview Rd Ste 126",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282102100",
            "country_code": "US",
            "telephone_number": "704-762-1361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HILL",
        "first_name": "MARQUITA",
        "middle_name": "SHANA",
        "credential": "LCMHCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-04",
        "last_updated": "2024-06-24",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "21615",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A16221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Holly, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.

Verify at the official NPI Registry.