Capeside Psychiatry, PLLC
Organization Active NPI Psychiatry Physician · Wilmington, NC
NPI 1760891980 · NPPES record last updated Aug 4, 2025
Key facts
- NPI
- 1760891980
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- CAPESIDE PSYCHIATRY, PLLC
- Practice address
- 311 Judges Rd Ste 4E
Wilmington, NC 28405-3655 - Phone
- (910) 791-6767
- Fax
- (910) 399-2190
- NPI assigned
- Aug 13, 2014
- Organization subpart
- No
Authorized official
- Name
- Amanda Dixon
- Title
- Credentialing Specialist
- Phone
- (910) 520-6756
Practitioners 30
-
Nneoma Ogonnaya Aham-Iroetugo, PMHNP-BC
-
Henok Mulugeta Denboba, PMHNP
-
Mary Petrina Goodwin, LCSW, LCAS-A
-
Jennifer Rotella, LCSW
-
Kylie Rebecca Scolaro-Conti, LCSWA
-
Tammy L Wright, LPC
-
Soni Anil, RN,MSN, PMHNP-BC
-
Vickie M Johnson, NURSE PRACTITIONER
-
Benjamin Robert Crawford, D.O.
-
Robert Faulkner, MD
-
Travis Money, PMHNP-BC, FNP-C
-
Charles Montjoy, LMCHC
-
Jenny Robbins Wood, MA LPC LCAS NCC CCS
-
La-Vonnie Joiner, PMHNP
-
Noel Trusal, CRNP, MSN
-
Kayla Masika Ulmer, APRN
-
Mary Michele Evans, APRN PMHNP
-
Andrietta Wright Barnett, DNP FNP-C PMHNP-BC
-
Natalie Dionne Haslem, PMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (5 enrollments) in NC, SC, GA, VA, TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141023001370 | NC | Part B Supplier - Clinic/Group Practice | 5991926560 |
Receives reassigned benefits from 22 practitioners Practice locations: Jacksonville, NC; Wilmington, NC |
| O20190607002038 | SC | Part B Supplier - Clinic/Group Practice | 5991926560 |
Receives reassigned benefits from 4 practitioners Practice locations: Ridgeland, SC |
| O20220510000949 | GA | Part B Supplier - Clinic/Group Practice | 5991926560 |
Receives reassigned benefits from 6 practitioners Practice locations: Blue Ridge, GA |
| O20220525000136 | VA | Part B Supplier - Clinic/Group Practice | 5991926560 |
Receives reassigned benefits from 2 practitioners Practice locations: Fredericksburg, VA |
| O20220720000099 | TN | Part B Supplier - Clinic/Group Practice | 5991926560 |
Receives reassigned benefits from 3 practitioners Practice locations: Roan Mountain, TN |
National Provider Directory
Locations
102 Elizabeth St
Ste D
Jacksonville, NC 28540
311 Judges Rd
Ste 4E
Wilmington, NC 28405
Phone 910791676724
11382 N Jacob Smart Blvd
Ste Cd
Ridgeland, SC 29936
8251 Highway 19 E
Ste 1
Roan Mountain, TN 37687
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes | ||
| Community/Behavioral Health Agency | 251S00000X |
Addresses
Primary practice location
311 Judges Rd Ste 4E
Wilmington, NC 28405-3655
Mailing address
311 Judges Rd Ste 4E
Wilmington, NC 28405-3655
Phone (910) 791-6767
Other practice location 1
102 Elizabeth St Ste D
Jacksonville, NC 28540-5681
Phone (910) 791-6767
Other providers in Wilmington, NC
- Cape Med Express, LLC
- Cape Medical, Inc.
- Gail Marie Capel
- Alexis Lankford Capell
- Capeside Addiction Care
- Carissa Caples
- Ronald Capleton
- Kelly L Capobianco
- Liza A Capozzi
- Linda D Cappiello
All providers in Wilmington, NC · Psychiatry Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.