NICOLLE ANDERSON PH.D. - NPI 1386859429 - Psychologist in Charlotte, NC

Q: What is the provider's specialty?

The provider's specialty is Psychologist with taxonomy code 103TC2200X and a focus in Clinical Child & Adolescent.

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About Nicolle Anderson Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLLE ANDERSON PH.D. (NPI 1386859429) is an individual clinical child & adolescent provider in Charlotte, North Carolina, licensed in North Carolina (102528) and active in the NPI registry since May 2007. She has opted out of Medicare through July 29, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1386859429

Entity TypeIndividualFemale

Primary Taxonomy103TC2200X

Provider Legal NameNICOLLE ANDERSONCredential: PH.D.

Location Address1905 J N PEASE PL, SUITE 104Charlotte, NC 28262-4557

Mailing Address8728 Arbor Commoms LnConcord, NC 28027-3575 · (704) 795-9150

Phone(704) 599-4679

Sole ProprietorYes

Enumeration DateMay 11, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1386859429 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · Clinical Child & AdolescentBehavioral Health & Social Service Providers

Taxonomy Code103TC2200X

License✔ Licensed in NC · 102528

Definition

A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents.

1905 J N PEASE PL, Charlotte, NC 28262

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Nicolle Anderson Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 29, 2024 through July 29, 2026.

Opt-Out Effective DateJuly 29, 2024

Opt-Out In Effect ThroughJuly 29, 2026Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.