Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicole Jane Thompson, PMHNP-BC, LCSW, LICSW

Individual provider Social Worker · NPI 1588824478

Nicole Jane Thompson, PMHNP-BC, LCSW, LICSW is a Nurse Practitioner in Charlotte, North Carolina. Qualified in 2022, 4 years ago. Practices with Southern Mentality PLLC, a 2-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Florida, Massachusetts, North Carolina and New York and 1 more.

Years since qualifying
4
Licensed in
FL, MA, NC, NY, TX
In the registry since
2008
Specialties on file
6
What do these letters mean?
PMHNP-BC — Psychiatric-Mental Health Nurse Practitioner, Board Certified
A board-certified psychiatric nurse practitioner.
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

8430 Medical Plaza Dr Ste 300
Charlotte, NC 28262-9758
Phone: (704) 910-6142
Fax: (980) 422-0106
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 5018004 (NC)
Social Worker Taxonomy 104100000X · Licence 076873 (NY)
Clinical Social Worker Taxonomy 1041C0700X · Licence SW11908 (FL)
Clinical Social Worker Taxonomy 1041C0700X · Licence 114912 (MA)
Clinical Social Worker Taxonomy 1041C0700X · Licence 53948 (TX)
Clinical Social Worker Taxonomy 1041C0700X · Licence C013102 (NC)

Record details

NPI number1588824478
Entity typeIndividual (Type 1)
GenderFemale
Credentials PMHNP-BC , LCSW , LICSW
Sole proprietorNo
NPI enumeratedJune 13, 2008
Last updated in NPPESJanuary 7, 2025
Certification dateJanuary 7, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Southern Mentality Pllc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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