Individual provider Active NPI

Brandon Ross Caulder, LCAS-A, LCSWA

  • Addiction (Substance Use Disorder) Counselor
  • Wilmington, NC
National Provider Identifier
1154041523
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
28472 Issued in NC
Practice address
615 Shipyard Blvd
Wilmington, NC 28412-6431
Phone
(910) 343-0145
Fax
(910) 341-5779
NPI assigned
Aug 29, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X MHL-065-011 NC
Clinical Social Worker 1041C0700X P019596 NC
Clinical Social Worker 1041C0700X MHL-065-011 NC
Case Manager/Care Coordinator 171M00000X MHL-065-011 NC
Addiction (Substance Use Disorder) Counselor 101YA0400X 28472 NC Primary

Addresses

Primary practice location

615 Shipyard Blvd
Wilmington, NC 28412-6431

Mailing address

615 Shipyard Blvd
Wilmington, NC 28412-6431
Phone (910) 343-0145

Other practice location 1

613 Shipyard Blvd
Wilmington, NC 28412-6492
Phone (910) 202-3860

Other identifiers 1

IdentifierTypeStateIssuer
8300416TMedicaidNC

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
I20240523004025 NC Practitioner - Mental Health Counselor 6305288150 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anchor Psychological and Counseling Services PLLCGroup PAC ID 7517096290, 14 clinicians

Practice addresses (Care Compare)

1442 Military Cutoff Rd
Unit B
Wilmington, NC 28403-3605
Phone (910) 270-9995

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28472NCMDAddiction (Substance Use Disorder) Counselor
P019596NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Anchor Psychological & Counseling Services PLLC CurrentSince Apr 1, 2024 Accepting new patients

Locations

16581 US Highway 17
Ste 600
Hampstead, NC 28443
Phone (910) 270-9995

1442 Military Cutoff Rd
Unit B
Wilmington, NC 28403
Phone (252) 822-4150

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1154041523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126431",
            "telephone_number": "910-343-0145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126431",
            "telephone_number": "910-343-0145",
            "fax_number": "910-341-5779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "613 Shipyard Blvd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284126492",
            "country_code": "US",
            "telephone_number": "910-202-3860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAULDER",
        "first_name": "BRANDON",
        "middle_name": "ROSS",
        "credential": "LCAS-A, LCSWA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-29",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "MHL-065-011",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P019596",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "MHL-065-011",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NC",
            "license": "MHL-065-011",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "28472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300416T",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.