Healthcare Provider Details

I. General information

NPI: 1992430532
Provider Name (Legal Business Name): HAYDEN MICHAEL NIELSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CROWNPOINT EXECUTIVE DR STE 100
CHARLOTTE NC
28227-6726
US

IV. Provider business mailing address

2400 CROWNPOINT EXECUTIVE DR STE 100
CHARLOTTE NC
28227-6726
US

V. Phone/Fax

Practice location:
  • Phone: 828-680-0466
  • Fax: 910-782-2026
Mailing address:
  • Phone: 828-680-0466
  • Fax: 910-782-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP017918
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: