Active NPI
Tatim Nedy Lace, LCSW-A
- Clinical Social Worker
- Charlotte, NC
National Provider Identifier
1497426787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P015109
- Practice address
- 700 East Blvd Ste 100
Charlotte, NC 28203-4892 - Phone
- (980) 477-0227
- Fax
- (704) 980-3082
- NPI assigned
- Sep 26, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | P015109 | NC | Primary |
Addresses
Primary practice location
700 East Blvd Ste 100
Charlotte, NC 28203-4892
Mailing address
700 East Blvd Ste 100
Charlotte, NC 28203-4892
Phone (980) 477-0227
Other practice location 1
5200 Park Rd Ste 218B
Charlotte, NC 28209-3650
Phone (866) 700-1606
Other names 1
- Tatim Nedy Brace
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P015109 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sparc Network | Clinical | Past | Accepting new patients |
| Sweeneypsych, PLLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Psychologist
- Charlotte, NC
- NPI 1841833761
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645574400000",
"number": "1497426787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 EAST BLVD STE 100",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282034892",
"telephone_number": "980-477-0227",
"fax_number": "704-980-3082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 EAST BLVD STE 100",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282034892",
"telephone_number": "980-477-0227",
"fax_number": "704-980-3082"
}
],
"practiceLocations": [
{
"address_1": "5200 Park Rd Ste 218B",
"address_purpose": "LOCATION",
"city": "Charlotte",
"state": "NC",
"postal_code": "282093650",
"country_code": "US",
"telephone_number": "866-700-1606",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LACE",
"first_name": "TATIM",
"middle_name": "NEDY",
"credential": "LCSW-A",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-09-26",
"last_updated": "2022-02-23",
"certification_date": "2022-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P015109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TATIM",
"last_name": "BRACE",
"middle_name": "NEDY",
"code": "1",
"type": "Former Name"
}
]
}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 Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.