Individual provider Active NPI

Kelli Cottrell, LCSWA

  • Clinical Social Worker
  • Wilmington, NC
National Provider Identifier
1154053635
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
P017658 Issued in NC
Practice address
1608 Queen St Ste 3
Wilmington, NC 28401-5527
Phone
(919) 790-8580
NPI assigned
Jun 24, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X P017658 NC Primary

Addresses

Primary practice location

1608 Queen St Ste 3
Wilmington, NC 28401-5527

Mailing address

2620 Northchase Pkwy SE Apt E204
Wilmington, NC 28405-2137
Phone (910) 391-6101

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
P017658NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Family Services of North Carolina LLC Clinical CurrentSince Jun 26, 2022 Accepting new patients

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": "1656028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1154053635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 NORTHCHASE PKWY SE APT E204",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284052137",
            "telephone_number": "910-391-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1608 QUEEN ST STE 3",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284015527",
            "telephone_number": "919-790-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COTTRELL",
        "first_name": "KELLI",
        "credential": "LCSWA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-24",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P017658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; 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.