Active NPI
Amore Nichole Jackson
- Developmental Therapist
- Charlotte, NC
National Provider Identifier
1174178024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 6120 Brookshire Blvd Ste W
Charlotte, NC 28216-3300 - Phone
- (980) 251-5899
- NPI assigned
- Aug 7, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Behavior Technician | 106S00000X | |||
| Pharmacy Technician | 183700000X | |||
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
6120 Brookshire Blvd Ste W
Charlotte, NC 28216-3300
Mailing address
1962 Hartford Dr
Gastonia, NC 28052-6050
Other practice location 1
1055 E Colorado Blvd Ste 560
Pasadena, CA 91106-2380
Phone (818) 241-6780
Other names 1
- Mrs. Amore Nichole Thompson
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702339200000",
"number": "1174178024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1962 HARTFORD DR",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280526050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6120 BROOKSHIRE BLVD STE W",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282163300",
"telephone_number": "980-251-5899"
}
],
"practiceLocations": [
{
"address_1": "1055 E Colorado Blvd Ste 560",
"address_purpose": "LOCATION",
"city": "Pasadena",
"state": "CA",
"postal_code": "911062380",
"country_code": "US",
"telephone_number": "818-241-6780",
"fax_number": "818-241-6853",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "AMORE",
"middle_name": "NICHOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-07",
"last_updated": "2023-12-12",
"certification_date": "2023-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AMORE",
"last_name": "THOMPSON",
"middle_name": "NICHOLE",
"prefix": "MRS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.