Nicole Shatell Mallory, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P022663 Issued in NC

Practice address

3623 Latrobe Dr Ste 119
Charlotte, NC 28211-1187

Phone

(980) 502-9615

NPI assigned

Aug 6, 2025

Last updated

Aug 6, 2025By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• A Jewel's Journey Therapeutic & Consulting Services PLLC

  • Clinical Social Worker
  • Charlotte, NC
  • NPI 1861220279
  NPD

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

{
    "created_epoch": "1754438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1528943875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 INTERFACE LN APT 201",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282621231",
            "telephone_number": "317-518-4741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 LATROBE DR STE 119",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111187",
            "telephone_number": "980-502-9615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "NICOLE",
        "middle_name": "SHATELL",
        "credential": "LCSWA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-06",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P022663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline E Malles
• Shwetha Mallesara Sudhakar
• Thierry Mitchel Mallet, M.D.
• Emily Mallobe
• Michael S Mallonee, MD
• Rosa Isadora Malloy Post, MD
• Faith Marie Malloy, PA-C
• Richard Malnati, MSW LCSW
• Caitlin Malon
• Brittany Nicole Malone, PA-C

• 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 Aug 6, 2025; 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.