Active NPI
David L. Nickelson, M.S.W., L.C.S.W.
- Clinical Social Worker
- Concord, NC
National Provider Identifier
1619081486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C001740
- Practice address
- 101 Cabarrus Ave E Ste 200
Concord, NC 28025-3781 - Phone
- (888) 849-7379
- Fax
- (855) 857-7333
- NPI assigned
- Aug 18, 2006
- Sex
- Male
- Sole proprietor
- No
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 | C001740 | NC | Primary |
Addresses
Primary practice location
101 Cabarrus Ave E Ste 200
Concord, NC 28025-3781
Mailing address
101 Cabarrus Ave E Ste 200
Concord, NC 28025-3781
Phone (888) 849-7379
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6003647 | Medicaid | NC | |
| 146CW | Other | NC | BCBS |
| 477039 | Other | NC | HUMANA GOLD CHOICE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C001740 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rockingham County Finance Office | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- State or Local Public Health Clinic/Center
- Reidsville, NC
- NPI 1306947445
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565049600000",
"number": "1619081486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 CABARRUS AVE E STE 200",
"city": "CONCORD",
"state": "NC",
"postal_code": "280253781",
"telephone_number": "888-849-7379",
"fax_number": "855-857-7333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 CABARRUS AVE E STE 200",
"city": "CONCORD",
"state": "NC",
"postal_code": "280253781",
"telephone_number": "888-849-7379",
"fax_number": "855-857-7333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKELSON",
"first_name": "DAVID",
"middle_name": "L.",
"credential": "M.S.W., L.C.S.W.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2019-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C001740",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6003647",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "146CW",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA GOLD CHOICE",
"identifier": "477039",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.