Jessica Clodfelter, MS, LCMHC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

12637 Issued in NC

Practice address

2627 Heather Glen LN
Charlotte, NC 28208-2577

Phone

(336) 337-1519

NPI assigned

Dec 27, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jessica Dawn Kowalski Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thriveworks Clinical - North Carolina PC

  • Mental Health Counselor
  • Raleigh, NC
  • NPI 1003303082
  Medicare reassignment NPD

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

{
    "created_epoch": "1482796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1982149142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2627 HEATHER GLEN LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282082577",
            "telephone_number": "336-337-1519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 HEATHER GLEN LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282082577",
            "telephone_number": "336-337-1519"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8007 N Point Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271063268",
            "country_code": "US",
            "telephone_number": "866-700-1606",
            "fax_number": "866-338-5921",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3314 16th Ave SE Ste 205",
            "address_purpose": "LOCATION",
            "city": "Conover",
            "state": "NC",
            "postal_code": "286139694",
            "country_code": "US",
            "telephone_number": "866-700-1606",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4035 University Pkwy",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "27106",
            "country_code": "US",
            "telephone_number": "336-397-1560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLODFELTER",
        "first_name": "JESSICA",
        "credential": "MS, LCMHC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-27",
        "last_updated": "2022-05-20",
        "certification_date": "2021-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "12637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "KOWALSKI",
            "middle_name": "DAWN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.