Individual provider Active NPI

Pholile Dlamini, PSYD

  • Clinical Psychologist
  • Cornelius, NC
National Provider Identifier
1205205143
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4916 Issued in NC
Practice address
18121 W Catawba Ave Ste 5
Cornelius, NC 28031-5641
Phone
(704) 755-5558
Fax
(704) 741-5250
NPI assigned
Sep 22, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 4916 NC Primary

Addresses

Primary practice location

18121 W Catawba Ave Ste 5
Cornelius, NC 28031-5641

Mailing address

20311 Chartwell Center Dr Unit 196
Cornelius, NC 28031-5282
Phone (704) 755-5558

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
4916NCMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Safety Harbor Assessment and Therapy Services, PLLC Clinical CurrentSince May 3, 2020 Accepting new patients

Locations

18121 W Catawba Ave
Ste 5
Cornelius, NC 28031
Phone (704) 755-5558

20311 Chartwell Center Dr
Unit 196
Cornelius, NC 28031

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": "1442880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587945600000",
    "number": "1205205143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20311 CHARTWELL CENTER DR UNIT 196",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280315282",
            "telephone_number": "704-755-5558",
            "fax_number": "704-741-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18121 W CATAWBA AVE STE 5",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280315641",
            "telephone_number": "704-755-5558",
            "fax_number": "704-741-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DLAMINI",
        "first_name": "PHOLILE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-22",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "4916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; 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.