Heather Staton Colomb, LCSW, LCAS-P

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

2300 Randolph Rd
Charlotte, NC 28207-1562

Phone

(704) 316-7760

Fax

(704) 316-7761

NPI assigned

Sep 22, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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 and National Provider Directory roles.

• Amity Medical Group, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
  • NPI 1003301300
  NPD (past)
• Carolinas Medical Center

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1982710554
  NPD (past)

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

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332115200000",
    "number": "1700110830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-316-7760",
            "fax_number": "704-316-7761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 RANDOLPH RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071562",
            "telephone_number": "704-316-7760",
            "fax_number": "704-316-7761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLOMB",
        "first_name": "HEATHER",
        "middle_name": "STATON",
        "credential": "LCSW, LCAS-P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-22",
        "last_updated": "2012-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "P005145",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Hughes Collis, MS, CCC-SLP
• Christina Collura, DO, MPH
• Rebecca Collver, M.D.
• Ashley Lauren Collyer, PA-C
• Matthew Gregory Colner, PA
• Joshua Richard Colombo, PA-C
• Lauren Williams Colombo, PA-C
• Melissa Colon-Roman, PA-C
• David Manuel Colon, MD
• John Paul Colosi

• 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 Mar 19, 2012; 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.