NPIMap

Organization Active NPI

Base, PLLC

  • Psychologist
  • Charlotte, NC
National Provider Identifier
1265936108
Registry record updated Aug 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
BASE, PLLC
Practice address
1515 Mockingbird LN Ste 580
Charlotte, NC 28209-3236
Phone
(704) 910-8381
Fax
(704) 981-8282
NPI assigned
Mar 23, 2018
Last updated
Aug 6, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2019

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

Authorized official

Name
Dr. Andrea Umbach Kettling, PSYDNPI 1396093233
Title
Co-Owner/Licensed Psychologist
Phone
(704) 910-8381

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Psychologist 103T00000X NU Primary
Cognitive & Behavioral Psychologist 103TB0200X NU

Addresses

Primary practice location

1515 Mockingbird LN Ste 580
Charlotte, NC 28209-3236

Mailing address

1515 Mockingbird LN Ste 580
Charlotte, NC 28209-3236
Phone (704) 910-8381

National Provider Directory

National Provider Directory

Locations

1515 Mockingbird Ln
Ste 580
Charlotte, NC 28209
Phone (704) 644-9237

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565049600000",
    "number": "1265936108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 MOCKINGBIRD LN STE 580",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093236",
            "telephone_number": "704-910-8381",
            "fax_number": "704-981-8282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 MOCKINGBIRD LN STE 580",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093236",
            "telephone_number": "704-910-8381",
            "fax_number": "704-981-8282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-23",
        "last_updated": "2019-08-06",
        "status": "A",
        "authorized_official_last_name": "KETTLING",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "UMBACH",
        "authorized_official_title_or_position": "CO-OWNER/LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "704-910-8381",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 6, 2019; 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.