Southern Family Medicine, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SOUTHERN FAMILY MEDICINE, INC.

Practice address

400 E Statesville Ave Ste 200
Mooresville, NC 28115-2588

Phone

(704) 360-8486

Fax

(704) 230-4674

NPI assigned

Oct 5, 2016

Last updated

Jan 14, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Angela Jarvis Micolucci, LCMHCSNPI 1740434315

Title

Ceo

Phone

(704) 953-4890

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16389/brand/1/csg/1/fhir/r4

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angela Jarvis Micolucci, LCMHCS

  • Professional Counselor
  • Mooresville, NC
  • NPI 1740434315
  Medicare reassignment Care Compare group NPD Authorized official
• Bethany Rachel Basnett, NP

  • Primary Care Nurse Practitioner
  • Mooresville, NC
  • NPI 1487718938
  Medicare reassignment Care Compare group NPD
• Jelena McKeithan

  • Family Nurse Practitioner
  • Davidson, NC
  • NPI 1245985092
  Medicare reassignment Care Compare group NPD
• Aimee Campbell Culler

  • Clinical Social Worker
  • Mooresville, NC
  • NPI 1215206214
  Medicare reassignment NPD
• Jacquelyn Dwelle McGinnis, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mooresville, NC
  • NPI 1750922779
  Medicare reassignment NPD
• Marcy Sue Speight, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Greenville, NC
  • NPI 1003946724
  Medicare reassignment NPD
• Anita Vaughan, MSN,PMHNP-BC, FNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Concord, NC
  • NPI 1710014022
  Medicare reassignment NPD
• Meredith Ashley Oldham Cullop, NP

  • Family Nurse Practitioner
  • Marion, VA
  • NPI 1194312496

  NC

  Medicare reassignment NPD
• Charly Marie Harris, LCAS

  • Addiction (Substance Use Disorder) Counselor
  • Yadkinville, NC
  • NPI 1790041515
  NPD
• India Munoz, LCMHCA

  • Mental Health Counselor
  • Mooresville, NC
  • NPI 1194525386
  NPD
• Rochelle Ridgill Trollinger, LCAS-A

  • Addiction (Substance Use Disorder) Counselor
  • Yadkinville, NC
  • NPI 1245865070
  NPD
• Kimberly Falon Barney, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Mooresville, NC
  • NPI 1811876378
  NPD (past)

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

{
    "created_epoch": "1475625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768348800000",
    "number": "1881144590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E STATESVILLE AVE STE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152588",
            "telephone_number": "704-360-8486",
            "fax_number": "704-230-4674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E STATESVILLE AVE STE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281152588",
            "telephone_number": "704-360-8486",
            "fax_number": "704-230-4674"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 Baker Rd",
            "address_purpose": "LOCATION",
            "city": "High Point",
            "state": "NC",
            "postal_code": "272632758",
            "country_code": "US",
            "telephone_number": "336-307-4075",
            "fax_number": "363-307-3745",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "121 Country Ln",
            "address_purpose": "LOCATION",
            "city": "Mocksville",
            "state": "NC",
            "postal_code": "270282588",
            "country_code": "US",
            "telephone_number": "336-677-3900",
            "fax_number": "336-677-3909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN FAMILY MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-05",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A",
        "authorized_official_last_name": "MICOLUCCI",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "JARVIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-953-4890",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCMHCS"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Miller Soper, LCAS, LCMHCA
• Christian Finn Sorensen, M.D.
• Elizabeth Meier Soriano, MA, CCC- SLP
• South Iredell Internal Medicine, PA
• Laura Souther
• Tondra L Sowell, MA
• Sherard Huffstetler Spangler, PA-C
• Daisy J Sparks, LMBT 11742
• Judith A Spaventa, MOT,OTR/L
• Speak to Me Inc

• Community/Behavioral Health Agency in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.