Healthcare Provider Details

I. General information

NPI: 1699652271
Provider Name (Legal Business Name): MICHAEL JAMES ANDERS LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 EXECUTIVE CENTER DR
CHARLOTTE NC
28212-8866
US

IV. Provider business mailing address

174 PINECREST LN
LEXINGTON NC
27292-9309
US

V. Phone/Fax

Practice location:
  • Phone: 336-837-5852
  • Fax:
Mailing address:
  • Phone: 336-837-5852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022669
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: