Heather Tidwell, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C10190 Issued in NC

Practice address

7810 Pineville Matthews Rd Ste 5
Charlotte, NC 28226-5300

Phone

(201) 906-1025

NPI assigned

Sep 3, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• B&G Counseling Services PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Charlotte, NC
  • NPI 1164038782
  NPD Authorized official
• Monarch

  • Community/Behavioral Health Agency
  • Greensboro, NC
  • NPI 1831465442
  NPD (past)
• Monarch

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1871016816
  NPD (past)

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

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1639504194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 ESTHER CT",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297085707",
            "telephone_number": "201-906-1025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7810 PINEVILLE MATTHEWS RD STE 5",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282265300",
            "telephone_number": "201-906-1025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 Clanton Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282171309",
            "country_code": "US",
            "telephone_number": "704-332-9001 x2330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1810 Back Creek Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "28213",
            "country_code": "US",
            "telephone_number": "704-206-2342",
            "fax_number": "704-900-6329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "HEATHER",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-03",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "A22125",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW36503",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C10190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Thyer
• Necole Antoinette Tibolla, FNP
• Cynthia Griffirth Tice, MA, LPC, NCC, CCAS
• Delaney Marie Tice
• Michelle Louise Tidd, PA
• John W. Tidwell II, MD
• Tony Maurice Tidwell
• Daniel J. Tierney, MD
• Ties That Bind Mental Health LLC
• Tiffani's Comfort Care

• 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 May 18, 2020; 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.