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General NPI Number Information
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NPI Number | 1174976344
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Entity Type | Individual
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Provider Name | TICOLA CALDWELL ROSS PHD, MSW, LCSWA
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Gender | Female
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 1977 J N PEASE PL STE 101
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City | CHARLOTTE
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State | NC
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Zip | 28262-4528
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Country | US
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Telephone | 980-313-3020
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Fax | 704-980-8023
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Provider Business Mailing Address
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Address Line | 2707 GREYLOCK CT
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City | CHARLOTTE
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State | NC
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Zip | 28213-4094
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P009466
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License Number State | NC
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