MEDICARE: NICHOLE POTTS GAUSE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C008563	NC

General Provider Information

NPI Number	:	1962823831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE POTTS GAUSE LCSW

Provider Business Mailing Address
First Line	:	2520 WINGDALE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5267
Country	:	US
Telephone Number	:	803-322-0593
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 WINGDALE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5267
Country	:	US
Telephone Number	:	803-322-0593
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	06/12/2026

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