Healthcare Provider Details

I. General information

NPI: 1780564708
Provider Name (Legal Business Name): NEURO NESTLINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N TRYON ST
CHARLOTTE NC
28202-0202
US

IV. Provider business mailing address

193 PRAIRIE DR
LEXINGTON NC
27292-7959
US

V. Phone/Fax

Practice location:
  • Phone: 704-458-4870
  • Fax:
Mailing address:
  • Phone: 704-458-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY MCCLENDON
Title or Position: MANAGER
Credential:
Phone: 704-458-4870