Healthcare Provider Details

I. General information

NPI: 1578787982
Provider Name (Legal Business Name): CARL NICHOLAS CORDONI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CENTER ST
JACKSONVILLE NC
28546-5708
US

IV. Provider business mailing address

123 DOCKSIDE DR
JACKSONVILLE NC
28546-9769
US

V. Phone/Fax

Practice location:
  • Phone: 910-219-8000
  • Fax: 910-219-8073
Mailing address:
  • Phone: 910-577-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number955
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number955
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number955
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number955
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number955
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number955
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number955
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number955
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 10
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number955
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: