Individual provider Active NPI

Kristin Mosley, LCMHC

  • Mental Health Counselor
  • Concord, NC
National Provider Identifier
1992388011
Registry record updated May 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
13056 Issued in NC
Practice address
5641 Poplar Tent Rd Ste 204
Concord, NC 28027-7588
Phone
(704) 561-1286
NPI assigned
May 5, 2021
Last updated
May 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 13056 NC Primary

Addresses

Primary practice location

5641 Poplar Tent Rd Ste 204
Concord, NC 28027-7588

Mailing address

4623 Meshack Ave
Charlotte, NC 28213-0236
Phone (704) 561-1286

Other identifiers 1

IdentifierTypeStateIssuer
758308OtherNCLICENSE

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250701000556 NC Practitioner - Mental Health Counselor 8224541461 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
May accept Medicare assignment
Group practices
Miracles Healing Centers IncGroup PAC ID 8729273594, 8 clinicians

Practice addresses (Care Compare)

111 Kilson Dr
Suite 201
Mooresville, NC 28117-8218
Phone (704) 664-1009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13056NCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Wellcomemd NC Clinic PLLC CurrentSince Mar 23, 2025 Accepting new patients
Miracles Healing Centers Inc Mental Health CurrentSince Mar 23, 2025 Accepting new patients

Locations

5641 Poplar Tent Rd
Ste 204
Concord, NC 28027
Phone (704) 262-3980

7480 Waterside Loop Rd
Ste 204
Denver, NC 28037
Phone (704) 483-3783

111 Kilson Dr
Ste 201
Mooresville, NC 28117
Phone (704) 444-0999

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": "1620172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746144000000",
    "number": "1992388011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4623 MESHACK AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282130236",
            "telephone_number": "704-561-1286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5641 POPLAR TENT RD STE 204",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280277588",
            "telephone_number": "704-561-1286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSLEY",
        "first_name": "KRISTIN",
        "credential": "LCMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-05",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "13056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "758308",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.