Nicolle Anderson, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

102528 Issued in NC

Practice address

1905 J N Pease PL
Suite 104
Charlotte, NC 28262-4557

Phone

(704) 599-4679

NPI assigned

May 11, 2007

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386859429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8728 ARBOR COMMOMS LN",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280273575",
            "telephone_number": "704-795-9150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 J N PEASE PL",
            "address_2": "SUITE 104",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624557",
            "telephone_number": "704-599-4679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "NICOLLE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NC",
            "license": "102528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Christian Anderson, MD
• Melody Grace Anderson, M.D.
• Meredith Canty Anderson, LCSW
• Michael Henry Anderson, DDS
• Natalie Ann Anderson, PHARM.D,
• Pamela Anderson, OCCUPATIONAL THERAPY
• Parker Reid Anderson, LCMHCA
• Paul E Anderson, PT OCS
• Robert Bentley Anderson, MD
• Rulondo Tehran Anderson Sr., MA, LPC

• Clinical Child & Adolescent Psychologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Child & Adolescent Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.