Kristina Richendollar, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C013918 Issued in NC

Practice address

109 Professional Park Dr Ste 100
Mooresville, NC 28117-5538

Phone

(704) 412-7502

NPI assigned

Jun 6, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Holistic Life Enrichment, PLLC

  • Clinical Social Worker
  • Mooresville, NC
  • NPI 1679215024
  Medicare reassignment NPD Authorized official
• Renee J Wolf Inc

  • Clinical Social Worker
  • Mooresville, NC
  • NPI 1912656232
  NPD

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1306375209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 PROFESSIONAL PARK DR STE 100",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 PROFESSIONAL PARK DR STE 100",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175538",
            "telephone_number": "704-412-7502"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Overhill Dr Ste 105",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281178232",
            "country_code": "US",
            "telephone_number": "980-430-9205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHENDOLLAR",
        "first_name": "KRISTINA",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-06",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C013918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alisa Kaye Gibson Richard, LCMHCA
• Gianna Richard, RD, LDN
• Katie Marie Richards, OT/L
• Abby Nicole Richardson, M.A., CCC-SLP
• Caressa Richardson, LCSW
• Taylor Ricketts, RN, IBCLC
• Lina Sihamath Ricks, PA-C
• Susan Spell Ricks, MSP, CCC-SLP
• Meghan Riddle Hunter
• Amy Marie Riecken, MSW LCSW-A

• Clinical Social Worker in Mooresville, NC
• Providers in Mooresville, 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 Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.