Kelcey Raye Nichols, LCSW, LCASA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C013736 Issued in NC

Practice address

533 Woodard Way NW
Concord, NC 28027-0281

Phone

(980) 277-4141

NPI assigned

Aug 13, 2018

Last updated

Mar 10, 2023By 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 4

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": "1534118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1255810917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 POPLAR TENT RD, STE 115",
            "address_2": "PMB 3044",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "28027",
            "telephone_number": "980-277-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 WOODARD WAY NW",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280270281",
            "telephone_number": "980-277-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "KELCEY",
        "middle_name": "RAYE",
        "credential": "LCSW, LCASA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-13",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "15305",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "107846",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "090826",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C013736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Nguyen
• Hong Thu T Nguyen
• Caroline Ashley Nichols, CRNA
• Dalton Edward Nichols, PA-C
• Danielle Lynn Nichols, PHARMD
• Secily Linker Nichols, LCMHC
• Wanda Sue Nichols, LCSW
• Amanda Kathryn Nicholson, PSYD
• Danielle Alexis Nicholson, DDS
• Robert James Nicholson Jr., MD

• Clinical Social Worker in Concord, NC
• Providers in Concord, 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 10, 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.

Verify at the official NPI Registry.