Healthcare Provider Details

I. General information

NPI: 1841151289
Provider Name (Legal Business Name): AMANDA KATHRYN NICHOLSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PROGRESS PL
CONCORD NC
28025-2449
US

IV. Provider business mailing address

2021 MORTON ST APT 223
CHARLOTTE NC
28208-5340
US

V. Phone/Fax

Practice location:
  • Phone: 866-272-7826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: