Kristina Denise McCollum, LCSWA LCASA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P015379 Issued in NC

Practice address

100 Billingsley Rd
Charlotte, NC 28211-1002

Phone

(704) 376-7447

NPI assigned

Nov 12, 2020

Last updated

Mar 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1225630502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BILLINGSLEY RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111002",
            "telephone_number": "704-376-7447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BILLINGSLEY RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111002",
            "telephone_number": "704-376-7447"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2644 Englehardt St",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282164408",
            "country_code": "US",
            "telephone_number": "704-430-6084",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1216 Mann Dr",
            "address_purpose": "LOCATION",
            "city": "Matthews",
            "state": "NC",
            "postal_code": "281055512",
            "country_code": "US",
            "telephone_number": "980-262-3043",
            "fax_number": "980-339-5617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCOLLUM",
        "first_name": "KRISTINA",
        "middle_name": "DENISE",
        "credential": "LCSWA LCASA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-12",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "26061",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P015379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Paul McClure, MD
• Theresa Joanne McClure, CRNA
• Leo Francis McCluskey, MD
• Sabrina Alicia McCluskey, FNP-BC
• Bailey Christine McCollum, MD
• Megan Elizabeth McComas, PHD
• Heather McComb
• Angela Lucille McConnell, CRNA
• Caitlin McConnell, CRNA
• Jennifer E McConnell, ED.S., LPA

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; 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.