Micum Health PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MICUM HEALTH PLLC

Practice address

10130 Mallard Creek Rd Ste 207
Charlotte, NC 28262-6003

Phone

(800) 470-8303

Fax

(704) 997-1588

NPI assigned

Aug 17, 2023

Organization subpart

No

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

Authorized official

Name

Tovakyshe Woullard, LCSW, LCAS-A, CADCNPI 1174142277

Title

Program Director

Phone

(800) 470-8303

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tovakyshe Woullard, LCSWA. LCAS-A

  • Clinical Social Worker
  • Kannapolis, NC
  • NPI 1174142277

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1376326850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4311 SCHOOL HOUSE CMNS # 174",
            "city": "HARRISBURG",
            "state": "NC",
            "postal_code": "280757510",
            "telephone_number": "800-470-8303",
            "fax_number": "704-997-1588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10130 MALLARD CREEK RD STE 207",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282626003",
            "telephone_number": "800-470-8303",
            "fax_number": "704-997-1588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICUM HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-17",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "WOULLARD",
        "authorized_official_first_name": "TOVAKYSHE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "800-470-8303",
        "authorized_official_credential": "LCSW, LCAS-A, CADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chenel Michel, M.D.
• Montana Mick, BSW
• Meredith A Mickalis
• Marcus Mickell
• Kenyah Monet Mickens-Smith, LMFT, LCAS
• Mid Carolina Cardiology 2LLC
• Mid Carolina Psychiatry, PA
• Mid-Atlantic Emergency Medical Associates, PLLC
• Mid-Charlotte Dermatology and Research PLLC
• Midas Homecare Services Inc

• 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 Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.