=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225514813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATASHA JONES KINTO MAED, LCMHC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2018
-----------------------------------------------------
Last Update Date | 09/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 HENRY BERRY RD
-----------------------------------------------------
City | ROWLAND
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28383-9491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-280-1392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1710
-----------------------------------------------------
City | PEMBROKE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28372-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-280-1392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 13354
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------