Individual provider Active NPI

Terri Williams-Whiteside, MSW

  • Clinical Social Worker
  • Charlotte, NC
National Provider Identifier
1972853174
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
10130 Mallard Creek Rd Ste 300
Charlotte, NC 28262-6001
Phone
(704) 287-4384
NPI assigned
Sep 14, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

10130 Mallard Creek Rd Ste 300
Charlotte, NC 28262-6001

Mailing address

10130 Mallard Creek Rd Ste 300
Charlotte, NC 28262-6001
Phone (980) 729-5240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161216000791 NC Practitioner - Clinical Social Worker 0547540163 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10130 Mallard Creek Rd
Suite 300
Charlotte, NC 28262-6001
Phone (980) 729-5240

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Home for Family Intimacy, PLLC Clinical CurrentSince Oct 19, 2016 Accepting new patients
Cityblock Medical Practice, P.a. CurrentSince Apr 1, 2023 Accepting new patients

Locations

4444 The Plaza
Unit 18
Charlotte, NC 28215

10130 Mallard Creek Rd
Ste 300
Charlotte, NC 28262
Phone (704) 944-3533

495 Flatbush Ave
Ste C5
Brooklyn, NY 11225
Phone (215) 588-1676

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681171200000",
    "number": "1972853174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10130 MALLARD CREEK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282626001",
            "telephone_number": "980-729-5240",
            "fax_number": "980-729-5025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10130 MALLARD CREEK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282626001",
            "telephone_number": "704-287-4384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS-WHITESIDE",
        "first_name": "TERRI",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-14",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.