DR. ANDREA UMBACH KETTLING PSY.D.
NPI 1396093233
Psychologist in Charlotte, NC

Active since August 27, 2012Opted out of Medicare · through Jan 1, 2028
1515 MOCKINGBIRD LN STE 580, CHARLOTTE, NC 28209(704) 910-8381 Get Directions Write a Review

NPPES record last updated: August 6, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 6, 2019, Oct 16, 2018, Oct 11, 2018 (3 updates tracked since 2018).

About Dr. Andrea Umbach Kettling Psy.d. NPPES

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

DR. ANDREA UMBACH KETTLING PSY.D. (NPI 1396093233) is an individual psychologist in Charlotte, North Carolina, licensed in North Carolina (4522) and active in the NPI registry since August 2012. She has opted out of Medicare through January 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1396093233
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. ANDREA UMBACH KETTLINGCredential: PSY.D.
Location Address1515 MOCKINGBIRD LN STE 580Charlotte, NC 28209-3236
Mailing Address1515 Mockingbird Ln Ste 580Charlotte, NC 28209-3236 · (704) 910-8381 · Fax (704) 981-8282
Sole ProprietorNo
Enumeration DateAugust 27, 2012
Last NPPES UpdateAugust 6, 20193 updates tracked since enumeration
NPI 1396093233 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in NC · 4522
Definition

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

Also ListedPsychologist · Cognitive & BehavioralTaxonomy 103TB0200X
1515 MOCKINGBIRD LN STE 580, Charlotte, NC 28209

Other Names 1

Professional Name (2)Dr. Andrea Marie Umbach Psy.d.

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Opted out of Medicare

Dr. Andrea Umbach Kettling Psy.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 January 1, 2020 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2020
Opt-Out In Effect ThroughJanuary 1, 2028Opt-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.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor (Mental Health)
1515 MOCKINGBIRD LN STE 580
CHARLOTTE, NC 28209
Psychologist
1515 MOCKINGBIRD LN STE 580
CHARLOTTE, NC 28209
Psychologist
1515 MOCKINGBIRD LN STE 580
CHARLOTTE, NC 28209
Psychologist
1515 MOCKINGBIRD LN STE 580
CHARLOTTE, NC 28209
Psychologist
1515 MOCKINGBIRD LN STE 580
CHARLOTTE, NC 28209
Psychologist
1515 MOCKINGBIRD LN STE 580
CHARLOTTE, NC 28209
Psychologist
1515 MOCKINGBIRD LN STE 580
CHARLOTTE, NC 28209
Psychologist
1515 MOCKINGBIRD LN STE 580
CHARLOTTE, NC 28209

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Andrea Kettling's NPI number?

The NPI number for Andrea Kettling is 1396093233. It was assigned to this individual provider in the NPPES registry on August 27, 2012. The provider is also known as Dr. Andrea Marie Umbach Psy.D..

Where is Andrea Kettling located?

Andrea Kettling practices at 1515 Mockingbird Ln Ste 580, Charlotte, NC 28209. The listed phone number is (704) 910-8381.

What is Andrea Kettling's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Andrea Kettling enrolled in Medicare?

No. Andrea Kettling has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Andrea Kettling was last updated on August 6, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.