Active NPI
Nishthaya Soukhanouvong, PSY.D
- Clinical Psychologist
- Charlotte, NC
National Provider Identifier
1699250969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5747
- Practice address
- 3743 Latrobe Dr
Charlotte, NC 28211-1164 - Phone
- (704) 826-2709
- Fax
- (571) 257-0906
- NPI assigned
- Oct 2, 2018
- Sex
- Female
- 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 Psychologist | 103TC0700X | 5747 | NC | Primary |
Addresses
Primary practice location
3743 Latrobe Dr
Charlotte, NC 28211-1164
Mailing address
3743 Latrobe Dr
Charlotte, NC 28211-1164
Phone (704) 826-2709
Other names 1
- Dr. Emily Soukhanouvong
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 |
|---|---|---|---|
| 5747 | NC | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701648000000",
"number": "1699250969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3743 LATROBE DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282111164",
"telephone_number": "704-826-2709",
"fax_number": "571-257-0906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3743 LATROBE DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282111164",
"telephone_number": "704-826-2709",
"fax_number": "571-257-0906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUKHANOUVONG",
"first_name": "NISHTHAYA",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-02",
"last_updated": "2023-12-04",
"certification_date": "2023-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "5747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "EMILY",
"last_name": "SOUKHANOUVONG",
"prefix": "DR.",
"credential": "PSY.D",
"code": "2",
"type": "Professional 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 Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.